Healthcare Provider Details

I. General information

NPI: 1083695142
Provider Name (Legal Business Name): KELLI BOWERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 N ELDORADO AVE
KLAMATH FALLS OR
97601-6418
US

IV. Provider business mailing address

2210 N ELDORADO AVE
KLAMATH FALLS OR
97601-6418
US

V. Phone/Fax

Practice location:
  • Phone: 541-883-1030
  • Fax:
Mailing address:
  • Phone: 541-883-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121040-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL13415
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier682028
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerDMBA
# 2
Identifier1041C0700X
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerTAXONOMY
# 3
Identifier261QR0405X
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerSUBSTANCE ABUSE
# 4
Identifier01210403501001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBLUE CROSS
# 5
IdentifierP00117833
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier942938348014
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 7
Identifier107032367010
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerIHC
# 8
Identifier942938348OLS
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEDUCATOR'S MUTUAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: