Healthcare Provider Details

I. General information

NPI: 1225713845
Provider Name (Legal Business Name): ROWAN E FOLEY LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 LAKE BLVD WL-228
DAVIS CA
95616-2614
US

IV. Provider business mailing address

2564 REGIS DR
DAVIS CA
95618-1557
US

V. Phone/Fax

Practice location:
  • Phone: 530-219-4309
  • Fax:
Mailing address:
  • Phone: 530-219-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: