Basic Information
| Provider Information | |||||||||
| NPI: | 1770642217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWLE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 ENERGY PARK DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1360 ENERGY PARK DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | LP1480 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TF0000X | LP1480 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103T00000X | LP1480 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | 103TP2701X | LP1480 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.