Provider Demographics
NPI:1124572458
Name:BOWIE, BRIE
Entity Type:Individual
Prefix:
First Name:BRIE
Middle Name:
Last Name:BOWIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:
Other - Last Name:BOLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17280 W NORTH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4366
Mailing Address - Country:US
Mailing Address - Phone:262-780-0707
Mailing Address - Fax:262-780-0717
Practice Address - Street 1:13900 W BURLEIGH RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3019
Practice Address - Country:US
Practice Address - Phone:262-781-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4147-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52-6552OtherMEDICARE#
WI1548242829Medicaid