Provider Demographics
NPI:1689905531
Name:CLAWSON, DOUGLAS ROCKWELL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ROCKWELL
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E 1950 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-3015
Mailing Address - Country:US
Mailing Address - Phone:801-317-3809
Mailing Address - Fax:385-405-2614
Practice Address - Street 1:298 24TH ST STE 204
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1870
Practice Address - Country:US
Practice Address - Phone:385-405-2533
Practice Address - Fax:385-405-2533
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-14171041C0700X
UT6720347-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18173560Medicaid