Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 348 | ND |
N | 103G00000X | Clinical Psychologist | 348 | ND |
N | 103TC0700X | Clinical Psychologist | 348 | ND |
N | 103TM1800X | Intellectual & Developmental Disabilities | 348 | ND |
NPI | 1033210570 |
---|---|
Provider Name | Ms. Leslie A Rowan |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 03/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11758 | (05) | ND |
22997 | BCBSND (01) | ND |
356J7RO | BCBSMN (01) | MN |
408918900 | (05) | MN |
A006 | TRICARE (01) | ND |
P54545 | (02) | ND |