Provider Demographics
NPI:1497047799
Name:COWAN, LAURA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:COWAN
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 1:500 3RD ST
Mailing Address - Street 2:SUITE 319B
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4885
Mailing Address - Country:US
Mailing Address - Phone:715-848-0202
Mailing Address - Fax:
Practice Address - Street 1:500 3RD ST
Practice Address - Street 2:SUITE 319B
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4885
Practice Address - Country:US
Practice Address - Phone:715-848-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2859 - 057103TC0700X
IN20040711A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical