Healthcare Provider Details

I. General information

NPI: 1235620444
Provider Name (Legal Business Name): ANN MARIE LOWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 E 12200 S STE G
DRAPER UT
84020-7861
US

IV. Provider business mailing address

264 E 12200 S STE G
DRAPER UT
84020-7861
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-8537
  • Fax:
Mailing address:
  • Phone: 801-214-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10588164-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: