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NPI Code Detail

MEDICARE: JEFF FOWLER STOUT ACMHC

MEDICARE: JEFF FOWLER STOUT ACMHC
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
11041C0700XClinical Social Worker5598941-6009UT

General Provider Information

NPI Number : 1538174222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF FOWLER STOUT ACMHC
Provider Business Mailing Address
First Line : 117 W 400 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84101-1916
Country : US
Telephone Number : 801-428-4257
Fax Number :
Provider Business Practice Location Address
First Line : 117 W 400 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84101-1916
Country : US
Telephone Number : 801-428-4257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 02/20/2025

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Directions to “ JEFF FOWLER STOUT ACMHC” Practice Location

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