Provider Demographics
NPI:1134466683
Name:COWAN, JESSICA LYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYN
Last Name:COWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W 100 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3229
Mailing Address - Country:US
Mailing Address - Phone:801-759-8558
Mailing Address - Fax:
Practice Address - Street 1:802 W 100 S
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3229
Practice Address - Country:US
Practice Address - Phone:435-319-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165617091172V00000X
UT11079157101YP2500X
UT11079157-3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor