Provider Demographics
NPI:1235946740
Name:ROWLEY, MALLORIE (CM, CPSS)
Entity type:Individual
Prefix:MRS
First Name:MALLORIE
Middle Name:
Last Name:ROWLEY
Suffix:
Gender:F
Credentials:CM, CPSS
Other - Prefix:MS
Other - First Name:MALLORIE
Other - Middle Name:
Other - Last Name:MADILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CM, CPSS
Mailing Address - Street 1:461 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:461 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2747
Practice Address - Country:US
Practice Address - Phone:661-713-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTACM-01882171M00000X
UT1472175T00000X
390200000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program