Provider Demographics
NPI:1912923616
Name:LOWRY, CANDACE ELIZABETH (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:ELIZABETH
Last Name:LOWRY
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 TRIMBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9084
Mailing Address - Country:US
Mailing Address - Phone:801-561-2140
Mailing Address - Fax:801-359-4021
Practice Address - Street 1:1054 E 900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1433
Practice Address - Country:US
Practice Address - Phone:801-561-2140
Practice Address - Fax:801-359-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT126654-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000077015Medicare ID - Type UnspecifiedSOCIAL WORK PROVIDER