Provider Demographics
NPI:1376781385
Name:BOWMAN, CHRISTIAN (SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:FANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5814
Mailing Address - Country:US
Mailing Address - Phone:704-355-4645
Mailing Address - Fax:704-355-4231
Practice Address - Street 1:16455 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7135
Practice Address - Country:US
Practice Address - Phone:704-801-3719
Practice Address - Fax:704-801-3705
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist