Healthcare Provider Details

I. General information

NPI: 1508130675
Provider Name (Legal Business Name): VICTORIA JEAN ROWE LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S ATLANTIC ST
SEATTLE WA
98144
US

IV. Provider business mailing address

6516 25TH AVE NE APT 2
SEATTLE WA
98115-7152
US

V. Phone/Fax

Practice location:
  • Phone: 801-661-2367
  • Fax:
Mailing address:
  • Phone: 801-661-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number176162766
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: