Healthcare Provider Details

I. General information

NPI: 1336756675
Provider Name (Legal Business Name): JESSICA ANNE COWAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 5TH AVE STE 800
SEATTLE WA
98101-3136
US

IV. Provider business mailing address

3616 E CHERRY ST
SEATTLE WA
98122-5244
US

V. Phone/Fax

Practice location:
  • Phone: 206-374-0109
  • Fax: 206-374-0108
Mailing address:
  • Phone: 206-953-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61101055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: