Individual
KELLI BOWERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2210 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6418
(541) 883-1030
Mailing address
2210 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6418
(541) 883-1030
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
L13415
OR
1041C0700X
Clinical Social Worker
121040-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01210403501001
BLUE CROSS
UT
01
—
1041C0700X
TAXONOMY
UT
01
—
107032367010
IHC
UT
01
—
261QR0405X
SUBSTANCE ABUSE
UT
01
—
682028
DMBA
UT
05
—
942938348014
—
UT
01
—
942938348OLS
EDUCATOR'S MUTUAL
UT
01
—
P00117833
RAILROAD MEDICARE
UT
Enumeration date
11/07/2005
Last updated
08/08/2022
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