Healthcare Provider Details

I. General information

NPI: 1063903821
Provider Name (Legal Business Name): TIA LYNN ROWLEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 200 N STE O
LOGAN UT
84321-4036
US

IV. Provider business mailing address

1240 W 3275 S
PERRY UT
84302-4211
US

V. Phone/Fax

Practice location:
  • Phone: 435-915-6777
  • Fax:
Mailing address:
  • Phone: 801-450-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9238062-3502
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: