Provider Demographics
NPI:1376271718
Name:SOWIN, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:SOWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6460 MESEDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1813
Mailing Address - Country:US
Mailing Address - Phone:408-893-8028
Mailing Address - Fax:
Practice Address - Street 1:6460 MESEDGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1813
Practice Address - Country:US
Practice Address - Phone:408-893-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM409592103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool