Provider Demographics
NPI:1033981253
Name:BOWEN, HEATHER ANASTASIA
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANASTASIA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 CENTRAL AVE # 4MCKINLEY
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3679
Mailing Address - Country:US
Mailing Address - Phone:707-630-4000
Mailing Address - Fax:
Practice Address - Street 1:2355 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3679
Practice Address - Country:US
Practice Address - Phone:707-672-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician