Provider Demographics
NPI:1073248001
Name:BOWEN, ELIZABETH JOCELYN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOCELYN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOCELYN
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14505 SW BELL RD.
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:971-712-4713
Mailing Address - Fax:
Practice Address - Street 1:693 12TH ST. SE.
Practice Address - Street 2:SUITE #210
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-383-1248
Practice Address - Fax:503-217-6526
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health