Provider Demographics
NPI:1598897506
Name:MCCOWAN, TESS MYRA
Entity Type:Individual
Prefix:MISS
First Name:TESS
Middle Name:MYRA
Last Name:MCCOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MYRA
Other - Last Name:MCCOWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3018 VELDEN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3454
Mailing Address - Country:US
Mailing Address - Phone:720-339-9553
Mailing Address - Fax:
Practice Address - Street 1:3018 VELDEN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3454
Practice Address - Country:US
Practice Address - Phone:720-339-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist