Provider Demographics
NPI:1033292321
Name:BOWMAN, BRENDA J (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 S 600 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-3033
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:
Practice Address - Street 1:1140 W 500 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2914
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:435-789-6325
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT282713-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical