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NPI Code Detail

MEDICARE: WESLEY COWAN LCSW

MEDICARE: WESLEY COWAN LCSW
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
11041C0700XClinical Social Worker375CO

General Provider Information

NPI Number : 1083805832
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY COWAN LCSW
Provider Business Mailing Address
First Line : 1 KALISA WAY STE 101
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3508
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Provider Business Practice Location Address
First Line : 2445 E CACHE LA POUDRE ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-4812
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2007
Last Update Date : 03/08/2023

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Directions to “ WESLEY COWAN LCSW” Practice Location

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