MEDICARE: DR. CANDACE ELIZABETH LOWRY DSW, 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	101YM0800X	Mental Health Counselor	126654-3501	UT

General Provider Information

NPI Number	:	1912923616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDACE ELIZABETH LOWRY DSW, LCSW

Provider Business Mailing Address
First Line	:	1153 TRIMBLE CREEK DR
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9084
Country	:	US
Telephone Number	:	801-561-2140
Fax Number	:	801-359-4021

Provider Business Practice Location Address
First Line	:	1054 E 900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1433
Country	:	US
Telephone Number	:	801-561-2140
Fax Number	:	801-359-4025

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/18/2011

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