Healthcare Provider Details

I. General information

NPI: 1548566755
Provider Name (Legal Business Name): SYDNEY MARIE ROWE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W LOTT ST
BUFFALO WY
82834-1642
US

IV. Provider business mailing address

890 N DESMET AVE
BUFFALO WY
82834-1520
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-5531
  • Fax:
Mailing address:
  • Phone: 307-217-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number726
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: