Provider Demographics
NPI:1033803671
Name:BOWLES, BRIANNA LEE (AUD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6961
Mailing Address - Country:US
Mailing Address - Phone:618-803-9181
Mailing Address - Fax:
Practice Address - Street 1:1179 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7377
Practice Address - Country:US
Practice Address - Phone:618-628-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist