Provider Demographics
NPI:1487736005
Name:KOWALSKI, MARYANNE LOUISE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:LOUISE
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-0391
Mailing Address - Country:US
Mailing Address - Phone:231-683-9890
Mailing Address - Fax:616-844-3006
Practice Address - Street 1:2700 BAKER ST FL 3
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-737-1335
Practice Address - Fax:231-737-0534
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065264101YA0400X, 101YM0800X
68010652641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI750910482Medicare UPIN
MI20366Medicare UPIN
MI20378Medicare UPIN
MI1712452Medicaid
MI750910902Medicare UPIN
MI750910903Medicare UPIN
MI750910910Medicare UPIN
MI20386Medicare UPIN
MI750910904Medicare UPIN
MIOP22320Medicare ID - Type Unspecified