Provider Demographics
NPI:1700136553
Name:MCGOWN, PATRICIA A
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MCGOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S MAIN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2241
Mailing Address - Country:US
Mailing Address - Phone:715-234-5679
Mailing Address - Fax:
Practice Address - Street 1:431 S MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2241
Practice Address - Country:US
Practice Address - Phone:715-234-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5007-125101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health