Provider Demographics
NPI:1700339314
Name:COWAN, RONDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 CAMERON PARK DR STE 219
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7978
Mailing Address - Country:US
Mailing Address - Phone:916-542-0188
Mailing Address - Fax:
Practice Address - Street 1:3161 CAMERON PARK DR STE 219
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7978
Practice Address - Country:US
Practice Address - Phone:916-542-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical