Provider Demographics
NPI:1871155986
Name:LISCHWE, JANE BOWMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:BOWMAN
Last Name:LISCHWE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:BOWMAN
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2614 KALMIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1448
Mailing Address - Country:US
Mailing Address - Phone:818-521-3236
Mailing Address - Fax:
Practice Address - Street 1:1818 VERDUGO BLVD STE 205
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1435
Practice Address - Country:US
Practice Address - Phone:818-952-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical