Provider Demographics
NPI:1033210570
Name:ROWAN, LESLIE A (PHD)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:ROWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SOUTH COLUMBIA ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-772-1588
Mailing Address - Fax:701-746-6077
Practice Address - Street 1:2100 SOUTH COLUMBIA ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-772-1588
Practice Address - Fax:701-746-6077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND348103TB0200X, 103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDA006OtherTRICARE
MN408918900Medicaid
MN356J7ROOtherBCBSMN
ND11758Medicaid
ND22997OtherBCBSND
MN356J7ROOtherBCBSMN
ND11758Medicaid