Provider Demographics
NPI:1306519939
Name:COWGER, JENNIFER ANN (LCSW, LCAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:COWGER
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2154
Mailing Address - Country:US
Mailing Address - Phone:121-990-2272
Mailing Address - Fax:
Practice Address - Street 1:196 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2154
Practice Address - Country:US
Practice Address - Phone:219-902-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006133A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical