Provider Demographics
NPI:1700767423
Name:COWANS, JALEEL
Entity type:Individual
Prefix:
First Name:JALEEL
Middle Name:
Last Name:COWANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21670 WHITMORE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2615
Mailing Address - Country:US
Mailing Address - Phone:313-402-7155
Mailing Address - Fax:
Practice Address - Street 1:21670 WHITMORE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2615
Practice Address - Country:US
Practice Address - Phone:313-402-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator