Provider Demographics
NPI:1043921786
Name:COWDIN, MICHAELA (RBT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:COWDIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:PENROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:4189 S 300 W APT C106
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3591
Mailing Address - Country:US
Mailing Address - Phone:385-775-2474
Mailing Address - Fax:
Practice Address - Street 1:4189 S 300 W APT C106
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3591
Practice Address - Country:US
Practice Address - Phone:385-775-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-22-241335106S00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician