Jena Cowen

Individual provider Active NPI Community/Behavioral Health Agency · Gillette, WY

NPI 1902298029 · NPPES record last updated Feb 8, 2019

Key facts

NPI
1902298029
Entity type
Individual (NPI type 1)
Primary specialty
Community/Behavioral Health Agency 251S00000X
Practice address
5305 Cowen Drive
Gillette, WY 82718
Phone
(307) 299-0567
NPI assigned
Feb 26, 2015
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X WY Yes

Addresses

Primary practice location

5305 Cowen Drive
Gillette, WY 82718

Mailing address

PO Box 3365
Gillette, WY 82717-3365
Phone (307) 299-0567

Other practice location 1

905 N Gurley Ave
Gillette, WY 82716-2109
Phone (307) 686-2530 ext. 4113

Other identifiers

IdentifierTypeStateIssuer
82-2756226MedicaidWY

Other providers in Gillette, WY

All providers in Gillette, WY · Community/Behavioral Health Agency in Wyoming

Sources for this page

Verify at the official NPI Registry.