MEDICARE: KELLI BOWERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	121040-3501	UT
2	101YP2500X	Professional Counselor	L13415	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00117833	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	682028	OTHER	UT	DMBA
2	1041C0700X	OTHER	UT	TAXONOMY
3	261QR0405X	OTHER	UT	SUBSTANCE ABUSE
4	01210403501001	OTHER	UT	BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	107032367010	OTHER	UT	IHC
8	942938348OLS	OTHER	UT	EDUCATOR'S MUTUAL

General Provider Information

NPI Number	:	1083695142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI BOWERS LCSW

Provider Business Mailing Address
First Line	:	2210 N ELDORADO AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-6418
Country	:	US
Telephone Number	:	541-883-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 N ELDORADO AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-6418
Country	:	US
Telephone Number	:	541-883-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/08/2022

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Directions to “ KELLI BOWERS LCSW” Practice Location

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