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General NPI Number Information
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NPI Number | 1588959571
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Entity Type | Organization
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Legal Business Name | LAURA B. COWAN PHD, LLC
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 500 3RD ST SUITE319B
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City | WAUSAU
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State | WI
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Zip | 54403-4885
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Country | US
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Telephone | 715-848-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 500 3RD ST SUITE319B
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City | WAUSAU
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State | WI
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Zip | 54403-4885
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Country | US
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Telephone | 715-848-0202
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LAURA B COWAN
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Credential | PHD
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Telephone | 715-848-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2859-057
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License Number State | WI
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