Provider Demographics
NPI:1912918988
Name:COWDEN, LISA SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUZANNE
Last Name:COWDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16122 8TH AVE SW
Mailing Address - Street 2:STE D2
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2049
Mailing Address - Country:US
Mailing Address - Phone:206-241-9068
Mailing Address - Fax:206-241-2651
Practice Address - Street 1:16122 8TH AVE SW
Practice Address - Street 2:STE D2
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2049
Practice Address - Country:US
Practice Address - Phone:206-241-9068
Practice Address - Fax:206-241-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPY1748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA149785Medicaid