Healthcare Provider Details

I. General information

NPI: 1003039827
Provider Name (Legal Business Name): DIANE B. ROWE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N MALL DR BLDG I 102
ST GEORGE UT
84790-7302
US

IV. Provider business mailing address

210 N MALL DR APT 10
ST GEORGE UT
84790-8178
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-9428
  • Fax: 435-673-1569
Mailing address:
  • Phone: 435-673-1569
  • Fax: 435-673-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number277799-3501
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: