Provider Demographics
NPI:1245463256
Name:COWAN, JASNA DEL CARMEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JASNA
Middle Name:DEL CARMEN
Last Name:COWAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 FERNANDEZ WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3330
Mailing Address - Country:US
Mailing Address - Phone:650-438-4631
Mailing Address - Fax:
Practice Address - Street 1:640 CRESPI DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3427
Practice Address - Country:US
Practice Address - Phone:650-438-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist