Provider Demographics
NPI:1184894453
Name:COWPER, AMY E (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:COWPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GOTHRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-789-5918
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-789-5971
Practice Address - Fax:517-789-5918
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089158104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker