Provider Demographics
NPI:1417621863
Name:BOWMAN, SARA LANEA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LANEA
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MANNON DR
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-9566
Mailing Address - Country:US
Mailing Address - Phone:304-923-8833
Mailing Address - Fax:
Practice Address - Street 1:110 MANNON DR
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-9566
Practice Address - Country:US
Practice Address - Phone:304-923-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0908Medicaid