Provider Demographics
NPI:1124808704
Name:ROWE, REBECCA W (LCSW C-SSWS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:W
Last Name:ROWE
Suffix:
Gender:F
Credentials:LCSW C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2104
Mailing Address - Country:US
Mailing Address - Phone:318-549-6116
Mailing Address - Fax:
Practice Address - Street 1:2500 VIKING DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2104
Practice Address - Country:US
Practice Address - Phone:318-549-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67811041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool