Basic Information
| Provider Information | |||||||||
| NPI: | 1073856191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 5TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342311 | ||||||||
| FaxNumber: | 7122342392 | ||||||||
| Practice Location | |||||||||
| Address1: | 917 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH SIOUX CITY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024943337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 06/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 890 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 075768 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.