Provider Demographics
NPI:1336820661
Name:BOWDEN, SAVANNAH JUSTINE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JUSTINE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S DENVER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-4773
Mailing Address - Country:US
Mailing Address - Phone:702-858-5805
Mailing Address - Fax:
Practice Address - Street 1:650 E 4500 S STE 300
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4502
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor