Healthcare Provider Details

I. General information

NPI: 1801582101
Provider Name (Legal Business Name): SARAH L BOWEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WESTOWN PKWY STE 230
WEST DES MOINES IA
50266-8297
US

IV. Provider business mailing address

4260 NW 164TH ST
CLIVE IA
50325-2515
US

V. Phone/Fax

Practice location:
  • Phone: 515-344-2060
  • Fax:
Mailing address:
  • Phone: 612-619-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH BOWEN
Title or Position: OWNER
Credential: LISW
Phone: 612-619-5193