MEDICARE: DEBRA BOWMAN 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	1041C0700X	Clinical Social Worker	310179-3501	UT

General Provider Information

NPI Number	:	1992814164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA BOWMAN LCSW

Provider Business Mailing Address
First Line	:	447 W BEARCAT DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2519
Country	:	US
Telephone Number	:	801-355-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 W BEARCAT DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2519
Country	:	US
Telephone Number	:	801-355-2846
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/09/2015

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