Provider Demographics
NPI:1669043493
Name:MOWERY, MEGHAN A (RCSWI)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:MOWERY
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 REVELL RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2419
Mailing Address - Country:US
Mailing Address - Phone:920-470-6618
Mailing Address - Fax:
Practice Address - Street 1:305 REVELL RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2419
Practice Address - Country:US
Practice Address - Phone:920-470-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW214231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15844OtherREGISTERED CLINICAL SOCIAL WORK INTERN