Courtney Kowalchuk, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW72909 Issued in CA

Practice address

673MDG
5955 Zeamer Avenue
Joint Base Elmendorf-Richardson, AK 99506

Phone

(907) 580-3205

NPI assigned

Mar 3, 2015

Last updated

Feb 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1104218924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673MDG",
            "address_2": "5955 ZEAMER AVENUE",
            "city": "JOINT BASE ELMENDORF-RICHARDSON",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673MDG",
            "address_2": "5955 ZEAMER AVENUE",
            "city": "JOINT BASE ELMENDORF-RICHARDSON",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-3205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3605 Vista Way",
            "address_2": "Suite 258",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "CA",
            "postal_code": "920564565",
            "country_code": "US",
            "telephone_number": "256-503-1440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOWALCHUK",
        "first_name": "COURTNEY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "101YM02800X",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW72909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Laurence Able, MD
• John Geselman, MD
• Jeffery Y Henderson, DMD
• Shannon Elisabeth Hunt, AUD, CCC-A
• Daniel Thomas Knudsen, PA-C
• Jacob Carl Shook, D.O.
• Zachary Trzinski

• Clinical Social Worker in Joint Base Elmendorf-Richardson, AK
• Providers in Joint Base Elmendorf-Richardson, AK by specialty
• Clinical Social Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.