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General NPI Number Information
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NPI Number | 1790892651
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Entity Type | Individual
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Provider Name | SHELLY J COWAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL ROAD PORTLAND VA MEDICAL CENTER
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 19417 SE 30TH ST
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City | CAMAS
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State | WA
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Zip | 98607-9437
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Country | US
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Telephone | 360-954-5452
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L3644
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License Number State | OR
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