Provider Demographics
NPI:1518402320
Name:BOWLING, LAURIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURIN
Middle Name:
Last Name:BOWLING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 LEGACY LAKE CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8760
Mailing Address - Country:US
Mailing Address - Phone:810-623-1698
Mailing Address - Fax:
Practice Address - Street 1:1762 N CROSSBERRY CV
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2449
Practice Address - Country:US
Practice Address - Phone:901-428-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist