Provider Demographics
NPI:1447245485
Name:MARIANNE G BOWDEN PHD
Entity Type:Organization
Organization Name:MARIANNE G BOWDEN PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-345-3461
Mailing Address - Street 1:365 RIFFEL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8592
Mailing Address - Country:US
Mailing Address - Phone:330-345-3461
Mailing Address - Fax:330-345-3462
Practice Address - Street 1:365 RIFFEL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8592
Practice Address - Country:US
Practice Address - Phone:330-345-3461
Practice Address - Fax:330-345-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9327471Medicare PIN