Provider Demographics
NPI:1790892651
Name:COWAN, SHELLY J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:J
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 1:19417 SE 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9437
Mailing Address - Country:US
Mailing Address - Phone:360-954-5452
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL ROAD
Practice Address - Street 2:PORTLAND VA MEDICAL CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL36441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical