Basic Information
| Provider Information | |||||||||
| NPI: | 1922343177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWAN | ||||||||
| FirstName: | SHERRIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8108 SE COCONUT ST | ||||||||
| Address2: | |||||||||
| City: | HOBE SOUND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334554008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Practice Location | |||||||||
| Address1: | 5420 CHARD TER | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339814963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 03/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BCBA/1-14-15617 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.