Healthcare Provider Details

I. General information

NPI: 1750020855
Provider Name (Legal Business Name): JWALKER INTENSIVE OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E 770 N
OREM UT
84097-4102
US

IV. Provider business mailing address

503 E 770 N
OREM UT
84097-4102
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-0388
  • Fax:
Mailing address:
  • Phone: 801-893-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MALLORY MARIE BOWEN
Title or Position: OWNER
Credential:
Phone: 801-420-3117