MEDICARE: TARAH RACHELE STOWELL 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	54221393501	UT

General Provider Information

NPI Number	:	1417101940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARAH RACHELE STOWELL L.C.S.W.

Provider Business Mailing Address
First Line	:	5280 BRIDLE WAY
Second Line	:
City	:	OAKLEY
State	:	UT
Zip	:	84055-2112
Country	:	US
Telephone Number	:	801-243-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 KILBY RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-8212
Country	:	US
Telephone Number	:	801-243-9994
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/17/2019

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