Healthcare Provider Details

I. General information

NPI: 1407356843
Provider Name (Legal Business Name): AMANDA COWAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY COWAN

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 525TH ST
RUSH CITY MN
55069-2227
US

IV. Provider business mailing address

1539 GUNSTON DR UNIT C
NEW RICHMOND WI
54017-2801
US

V. Phone/Fax

Practice location:
  • Phone: 320-358-0519
  • Fax:
Mailing address:
  • Phone: 715-559-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12459-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: