Provider Demographics
NPI:1073803169
Name:BOWEN, KIMBERLY LURIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LURIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 STERLING PINE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7431
Mailing Address - Country:US
Mailing Address - Phone:407-330-0542
Mailing Address - Fax:407-330-0542
Practice Address - Street 1:132 STERLING PINE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7431
Practice Address - Country:US
Practice Address - Phone:407-330-0542
Practice Address - Fax:407-330-0542
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist