Provider Demographics
NPI:1982938031
Name:SCOW, PENELOPE SUE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:SUE
Last Name:SCOW
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 1:3862 SENNIE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-3108
Mailing Address - Country:US
Mailing Address - Phone:801-884-6779
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 28
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5176
Practice Address - Country:US
Practice Address - Phone:801-501-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7675576-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health