Provider Demographics
NPI:1326686171
Name:ROWAN-MARTIN, SOFIA ANA (BA)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:ANA
Last Name:ROWAN-MARTIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3306
Mailing Address - Country:US
Mailing Address - Phone:651-318-2760
Mailing Address - Fax:651-478-6920
Practice Address - Street 1:752 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3306
Practice Address - Country:US
Practice Address - Phone:651-318-2760
Practice Address - Fax:651-478-6920
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional