Healthcare Provider Details

I. General information

NPI: 1649567033
Provider Name (Legal Business Name): KIMBERLI A BOWMAN LMT, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7548 S 1655 W
WEST JORDAN UT
84084-4029
US

IV. Provider business mailing address

7548 S 1655 W
WEST JORDAN UT
84084-4029
US

V. Phone/Fax

Practice location:
  • Phone: 801-318-5015
  • Fax:
Mailing address:
  • Phone: 801-318-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14158227-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number366756-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: