Healthcare Provider Details

I. General information

NPI: 1265040927
Provider Name (Legal Business Name): JULIE A GOWER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17548 VETERANS MEMORIAL HWY
KINGWOOD WV
26537-9797
US

IV. Provider business mailing address

17548 VETERANS MEMORIAL HWY
KINGWOOD WV
26537-9797
US

V. Phone/Fax

Practice location:
  • Phone: 304-441-2001
  • Fax: 304-441-2009
Mailing address:
  • Phone: 304-441-2001
  • Fax: 304-441-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberAP00938990
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberAP00938990
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00938990
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: