Provider Demographics
NPI:1043361439
Name:BOWDEN, JILL ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ELIZABETH
Other - Last Name:BOWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:900 WESTFALL RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2635
Mailing Address - Country:US
Mailing Address - Phone:585-472-2588
Mailing Address - Fax:
Practice Address - Street 1:900 WESTFALL RD STE D
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2635
Practice Address - Country:US
Practice Address - Phone:585-472-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017502-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical