Provider Demographics
NPI:1386695435
Name:COGWELL ANDERSON, REBECCA C (PHD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:C
Last Name:COGWELL ANDERSON
Suffix:
Gender:F
Credentials:PHD
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:959 N MAYFAIR RD
Mailing Address - Street 2:MCW PAIN MANAGEMENT CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3465
Mailing Address - Country:US
Mailing Address - Phone:414-955-7601
Mailing Address - Fax:414-955-6020
Practice Address - Street 1:959 N MAYFAIR RD
Practice Address - Street 2:MCW PAIN MANAGEMENT CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3465
Practice Address - Country:US
Practice Address - Phone:414-955-7601
Practice Address - Fax:414-955-6020
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386695435Medicaid
002000108DOtherHUMANA
WI012J 73-601Medicare PIN
R39565Medicare UPIN