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General NPI Number Information
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NPI Number | 1710489745
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Entity Type | Individual
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Provider Name | KAITLIN BETH COWAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 126 W RUSH ST
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City | KENDALLVILLE
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State | IN
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Zip | 46755-1740
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Country | US
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Telephone | 260-347-2502
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Fax |
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Provider Business Mailing Address
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Address Line | 126 W RUSH ST
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City | KENDALLVILLE
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State | IN
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Zip | 46755-1740
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Country | US
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Telephone | 260-347-2502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5317
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 5317
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10243827
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License Number State | IN
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