Provider Demographics
NPI:1497486690
Name:FARKAS-BOWSER, LAURA (CSW, TCADC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FARKAS-BOWSER
Suffix:
Gender:F
Credentials:CSW, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MUHAMMAD ALI BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1643
Mailing Address - Country:US
Mailing Address - Phone:502-568-6758
Mailing Address - Fax:
Practice Address - Street 1:700 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1643
Practice Address - Country:US
Practice Address - Phone:502-568-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY256421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker