Provider Demographics
NPI:1417940180
Name:GOWER, JACQUELINE L (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:L
Last Name:GOWER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6518
Mailing Address - Country:US
Mailing Address - Phone:610-866-6855
Mailing Address - Fax:610-866-6715
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:610-866-6855
Practice Address - Fax:610-866-6715
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC003559OtherLICENSED PROF. COUNSELOR
PAPC003559OtherLICENSED PROF. COUNSELOR