Provider Demographics
NPI:1205197266
Name:BOWEN, JOHN R (MS-SPED)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MS-SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2609
Mailing Address - Country:US
Mailing Address - Phone:716-338-0668
Mailing Address - Fax:866-694-4979
Practice Address - Street 1:774 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2609
Practice Address - Country:US
Practice Address - Phone:716-338-0668
Practice Address - Fax:866-694-4979
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630951122174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist