Provider Demographics
NPI:1871668889
Name:FOWERS, DAVID J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:FOWERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DAVE
Other - Middle Name:J
Other - Last Name:FOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4080 ECCLES AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2458
Mailing Address - Country:US
Mailing Address - Phone:801-392-4226
Mailing Address - Fax:
Practice Address - Street 1:4080 ECCLES AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2458
Practice Address - Country:US
Practice Address - Phone:801-392-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12826235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical