Provider Demographics
NPI:1225713845
Name:FOLEY, ROWAN E (LEP)
Entity Type:Individual
Prefix:
First Name:ROWAN
Middle Name:E
Last Name:FOLEY
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-1557
Mailing Address - Country:US
Mailing Address - Phone:530-219-4309
Mailing Address - Fax:
Practice Address - Street 1:1260 LAKE BLVD
Practice Address - Street 2:WL-228
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2614
Practice Address - Country:US
Practice Address - Phone:530-219-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4295103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool