Healthcare Provider Details

I. General information

NPI: 1578858684
Provider Name (Legal Business Name): SUSAN COWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EXECUTIVE PARK BLVD STE 4600
SAN FRANCISCO CA
94134-3336
US

IV. Provider business mailing address

1418 10TH AVE APT 1
SAN FRANCISCO CA
94122-3662
US

V. Phone/Fax

Practice location:
  • Phone: 415-656-0116
  • Fax:
Mailing address:
  • Phone: 415-656-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: