MEDICARE: MRS. MIMI ANN COGSWELL MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C1561	OR

General Provider Information

NPI Number	:	1063494482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIMI ANN COGSWELL MS, LPC

Provider Business Mailing Address
First Line	:	17520 HOLLY LN
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-8523
Country	:	US
Telephone Number	:	503-740-5742
Fax Number	:	503-722-3964

Provider Business Practice Location Address
First Line	:	714B MAIN ST
Second Line	:	SUITE 201
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1821
Country	:	US
Telephone Number	:	503-740-5742
Fax Number	:	503-722-3964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	07/08/2007

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