Provider Demographics
NPI:1871194530
Name:BOWN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BOWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 75 W
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1043
Mailing Address - Country:US
Mailing Address - Phone:435-773-2265
Mailing Address - Fax:
Practice Address - Street 1:466 W 4800 N STE 180
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5705
Practice Address - Country:US
Practice Address - Phone:800-832-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical