Provider Demographics
NPI:1285847178
Name:BOWEN, SUSAN M (MHSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MHSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319
Mailing Address - Country:US
Mailing Address - Phone:708-932-4054
Mailing Address - Fax:219-924-1121
Practice Address - Street 1:607 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319
Practice Address - Country:US
Practice Address - Phone:708-932-4054
Practice Address - Fax:219-924-1121
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003766A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist