Provider Demographics
NPI:1932230059
Name:COWAN, SUSAN LEE (MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:COWAN
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 1:2601 TIOGA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8026
Mailing Address - Country:US
Mailing Address - Phone:209-848-8320
Mailing Address - Fax:
Practice Address - Street 1:112 E FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0221
Practice Address - Country:US
Practice Address - Phone:209-602-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist