Provider Demographics
NPI:1255319521
Name:BOWEN, DALE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 N 8TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8857
Mailing Address - Country:US
Mailing Address - Phone:970-245-3505
Mailing Address - Fax:
Practice Address - Street 1:2530 N 8TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8857
Practice Address - Country:US
Practice Address - Phone:970-245-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1137103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07116700Medicaid
COR18692Medicare UPIN
CO07116700Medicaid