Provider Demographics
NPI:1447508973
Name:KOWALCZYK, PAUL (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KOWALCZYK
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 WINDRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8005
Mailing Address - Country:US
Mailing Address - Phone:303-359-1108
Mailing Address - Fax:
Practice Address - Street 1:2907 WINDRIDGE CIR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-8005
Practice Address - Country:US
Practice Address - Phone:303-359-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09125402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist