Provider Demographics
NPI:1275534505
Name:BOWEN, JULIEANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIEANNA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29073 DAVISSON AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MN
Mailing Address - Zip Code:55065-9581
Mailing Address - Country:US
Mailing Address - Phone:651-278-4699
Mailing Address - Fax:
Practice Address - Street 1:9220 BASS LAKE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3000
Practice Address - Country:US
Practice Address - Phone:763-533-0363
Practice Address - Fax:763-533-0842
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103171174400000X
MN6908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No174400000XOther Service ProvidersSpecialist