Healthcare Provider Details

I. General information

NPI: 1578705893
Provider Name (Legal Business Name): SYLVIA BOWEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 BUNKER AVE
AZTEC NM
87410-2307
US

IV. Provider business mailing address

2979 COUNTY ROAD 222
DURANGO CO
81303-8166
US

V. Phone/Fax

Practice location:
  • Phone: 208-260-2821
  • Fax:
Mailing address:
  • Phone: 970-889-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08798
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: