Healthcare Provider Details

I. General information

NPI: 1548183395
Provider Name (Legal Business Name): QUANNAH ELIZABETH PARKER-MCGOWAN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

IV. Provider business mailing address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

V. Phone/Fax

Practice location:
  • Phone: 617-380-4328
  • Fax:
Mailing address:
  • Phone: 617-380-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP7361
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: