MEDICARE: MS. JULIE ANN MOWATT L.C.S.W.

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	L3858	OR

General Provider Information

NPI Number	:	1093903809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ANN MOWATT L.C.S.W.

Provider Business Mailing Address
First Line	:	2079 KNOWLES RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-9530
Country	:	US
Telephone Number	:	541-245-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 N 5TH ST
Second Line	:	#C
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9016
Country	:	US
Telephone Number	:	541-245-4446
Fax Number	:

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	07/08/2010

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