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NPI Code Detail

MEDICARE: SUZAN E. COWAN ACSW

MEDICARE: SUZAN E. COWAN ACSW
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 WorkerACSW15121CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ACSW15121OTHERCAASSOC.CLINICAL SOCIAL WOR

General Provider Information

NPI Number : 1154540631
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZAN E. COWAN ACSW
Provider Business Mailing Address
First Line : 1001 BROADWAY
Second Line : SUITE 201
City : JACKSON
State : CA
Zip : 95642-2649
Country : US
Telephone Number : 209-223-6412
Fax Number : 209-223-0920
Provider Business Practice Location Address
First Line : 1001 BROADWAY
Second Line : SUITE 201
City : JACKSON
State : CA
Zip : 95642-2649
Country : US
Telephone Number : 209-223-6412
Fax Number : 209-223-0920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 07/08/2007

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Directions to “ SUZAN E. COWAN ACSW” Practice Location

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