Provider Demographics
NPI:1104958180
Name:ROWEN, LAUDON (MFT)
Entity type:Individual
Prefix:
First Name:LAUDON
Middle Name:
Last Name:ROWEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2733
Mailing Address - Country:US
Mailing Address - Phone:916-251-1050
Mailing Address - Fax:916-630-1977
Practice Address - Street 1:5180 GROVE ST
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2733
Practice Address - Country:US
Practice Address - Phone:916-251-1050
Practice Address - Fax:916-630-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9602OtherPLACER COUNTY PROVIDER #