Provider Demographics
NPI:1811614902
Name:ROWE, ETHAN (CSW)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 S WASATCH BLVD APT I2
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4649
Mailing Address - Country:US
Mailing Address - Phone:206-909-0122
Mailing Address - Fax:
Practice Address - Street 1:7430 S WASATCH BLVD APT I2
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-4649
Practice Address - Country:US
Practice Address - Phone:206-909-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11860143-35031041C0700X
UT11860143-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical