Provider Demographics
NPI:1336333533
Name:COWAN, MISHELE LEIGH (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MISHELE
Middle Name:LEIGH
Last Name:COWAN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:MISS
Other - First Name:MISHELE
Other - Middle Name:LEIGH
Other - Last Name:SKOLODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:326 N LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627-1633
Mailing Address - Country:US
Mailing Address - Phone:724-739-0051
Mailing Address - Fax:
Practice Address - Street 1:326 N LIGONIER ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627-1633
Practice Address - Country:US
Practice Address - Phone:724-739-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004936L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist