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NPI Code Detail

MEDICARE: CARLA COWAN

MEDICARE: CARLA COWAN
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
1103TC0700XClinical Psychologist3644MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1716118200OTHERMNMEDICAL ASSISTANCE
21598830705OTHERMNNPI

General Provider Information

NPI Number : 1598830705
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA COWAN
Provider Business Mailing Address
First Line : 1275 BELMONT LN W
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-5901
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2006
Last Update Date : 01/16/2019

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Directions to “ CARLA COWAN ” Practice Location

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