Provider Demographics
NPI:1275916793
Name:ROWE, PHYLLIS (LCSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 N DOULTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-5455
Mailing Address - Country:US
Mailing Address - Phone:573-703-6119
Mailing Address - Fax:
Practice Address - Street 1:2909 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-803-1402
Practice Address - Fax:573-803-1405
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker