Provider Demographics
NPI:1396568564
Name:COWSERT, DESTINY JOANN (MA)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:JOANN
Last Name:COWSERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N040 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3909
Mailing Address - Country:US
Mailing Address - Phone:630-664-5419
Mailing Address - Fax:
Practice Address - Street 1:527 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3335
Practice Address - Country:US
Practice Address - Phone:630-549-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor