MEDICARE: ETHAN ROWE CSW

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	11860143-3503	UT
2	1041C0700X	Clinical Social Worker	11860143-3502	UT

General Provider Information

NPI Number	:	1811614902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN ROWE CSW

Provider Business Mailing Address
First Line	:	7430 S WASATCH BLVD APT I2
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4649
Country	:	US
Telephone Number	:	206-909-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 S WASATCH BLVD APT I2
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4649
Country	:	US
Telephone Number	:	206-909-0122
Fax Number	:

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	08/28/2024

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Directions to “ ETHAN ROWE CSW” Practice Location

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