Provider Demographics
NPI:1720012933
Name:SOWLE, SHAUN O (LCSW CAC III)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:O
Last Name:SOWLE
Suffix:
Gender:F
Credentials:LCSW CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-0529
Mailing Address - Country:US
Mailing Address - Phone:970-323-6141
Mailing Address - Fax:855-299-8071
Practice Address - Street 1:1010 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4831
Practice Address - Country:US
Practice Address - Phone:970-497-3333
Practice Address - Fax:855-299-7837
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5538101YA0400X
CO9925411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C442908Medicare ID - Type Unspecified