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General NPI Number Information
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NPI Number | 1538453584
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Entity Type | Organization
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Legal Business Name | GREGORY COWAN LLC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 3301 CRANBERRY BLVD FLOOR 2
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City | WESTON
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State | WI
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Zip | 54476-5216
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Country | US
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Telephone | 715-393-3953
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 WOODLAND RIDGE RD
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City | WAUSAU
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State | WI
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Zip | 54403-2362
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Country | US
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Telephone | 715-675-2183
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | GREGORY SCOTT COWAN
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Credential | PH.D.
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Telephone | 715-393-3953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2343-57
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License Number State | WI
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