Provider Demographics
NPI:1962071332
Name:ROWAN-NICHOLS, JO ANN (LMSW)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:ROWAN-NICHOLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29845 AIRPORT WAY GOLD BEACH, OR 97444
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-8028
Mailing Address - Country:US
Mailing Address - Phone:541-671-0859
Mailing Address - Fax:
Practice Address - Street 1:615 5TH ST # 300
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9199
Practice Address - Country:US
Practice Address - Phone:541-425-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64473104100000X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker