Provider Demographics
NPI:1255479093
Name:BOWLING, SHALENE KING
Entity Type:Individual
Prefix:
First Name:SHALENE
Middle Name:KING
Last Name:BOWLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALENE
Other - Middle Name:D
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:503 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-8201
Mailing Address - Country:US
Mailing Address - Phone:662-424-9500
Mailing Address - Fax:662-424-9592
Practice Address - Street 1:503 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-8201
Practice Address - Country:US
Practice Address - Phone:662-424-9500
Practice Address - Fax:662-424-9592
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist