Healthcare Provider Details

I. General information

NPI: 1376411504
Provider Name (Legal Business Name): HAILEY MAQAEL BOWLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 300 N STE 1
HYDE PARK UT
84318-4135
US

IV. Provider business mailing address

30 FAIRWAY LN
LOGAN UT
84321-5942
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9338
  • Fax:
Mailing address:
  • Phone: 951-219-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12886194-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number12886194-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: