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NPI Code Detail

MEDICARE: JAMIE COWGER

MEDICARE: JAMIE COWGER
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.167156OH

General Provider Information

NPI Number : 1104316140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE COWGER
Provider Business Mailing Address
First Line : 530 BOARDMAN CANFIELD RD APT 73
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-4727
Country : US
Telephone Number : 330-770-8447
Fax Number :
Provider Business Practice Location Address
First Line : 960 BOARDMAN CANFIELD RD
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44512-4220
Country : US
Telephone Number : 330-953-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2018
Last Update Date : 05/15/2018

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