Provider Demographics
NPI:1992145288
Name:BUCKLEY, ROWAN P (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROWAN
Middle Name:P
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 OWEN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:MN
Mailing Address - Zip Code:55357-9713
Mailing Address - Country:US
Mailing Address - Phone:612-916-1147
Mailing Address - Fax:
Practice Address - Street 1:6825 OWEN ST STE 201
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:MN
Practice Address - Zip Code:55357-9713
Practice Address - Country:US
Practice Address - Phone:612-916-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5599103TC2200X, 103TF0000X, 103TM1800X, 103TR0400X, 103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral