1871940544 NPI number — MS. JACQUELINE SIMONE COWELL B.S., QMHA

Table of content: MS. JACQUELINE SIMONE COWELL B.S., QMHA (NPI 1871940544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871940544 NPI number — MS. JACQUELINE SIMONE COWELL B.S., QMHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWELL
Provider First Name:
JACQUELINE
Provider Middle Name:
SIMONE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.S., QMHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COWELL
Provider Other First Name:
JACKIE
Provider Other Middle Name:
SIMONE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.S., QMHA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871940544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SHELTON MCMURPHEY BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-5015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-210-8090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SHELTON MCMURPHEY BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-210-8090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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