Individual
CARLA COWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
451 LEXINGTON PKWY N, SAINT PAUL, MN 55104-4636
(651) 280-2310
Mailing address
1275 BELMONT LN W, ROSEVILLE, MN 55113-5901
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3644
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598830705
NPI
MN
01
—
716118200
MEDICAL ASSISTANCE
MN
Enumeration date
11/22/2006
Last updated
01/16/2019
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