Provider Demographics
NPI:1649011065
Name:MCKOWEN, DEBRA IRENE (SUDC, SSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:IRENE
Last Name:MCKOWEN
Suffix:
Gender:F
Credentials:SUDC, SSW
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 3872
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3872
Mailing Address - Country:US
Mailing Address - Phone:801-521-4227
Mailing Address - Fax:801-359-0777
Practice Address - Street 1:352 S DENVER ST STE 350
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3059
Practice Address - Country:US
Practice Address - Phone:801-521-4227
Practice Address - Fax:801-359-0777
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)