Provider Demographics
NPI:1093027377
Name:BOWLES, STEPHANIE JAN (MED,CRC,LPC,NCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JAN
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MED,CRC,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5425
Mailing Address - Country:US
Mailing Address - Phone:208-585-1643
Mailing Address - Fax:
Practice Address - Street 1:215 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-6155
Practice Address - Country:US
Practice Address - Phone:208-595-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4032101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor