Provider Demographics
NPI:1326689183
Name:BOWLES, ERICA DANIELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-4147
Mailing Address - Country:US
Mailing Address - Phone:573-576-1456
Mailing Address - Fax:
Practice Address - Street 1:1451 DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-4147
Practice Address - Country:US
Practice Address - Phone:573-576-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018030504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist