Provider Demographics
NPI:1225250178
Name:BOWMAN, MARIA TERESA (SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 E SENECA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5582
Mailing Address - Country:US
Mailing Address - Phone:520-298-1081
Mailing Address - Fax:
Practice Address - Street 1:4355 E CALLE AURORA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6329
Practice Address - Country:US
Practice Address - Phone:520-584-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL0112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ595051Medicaid