Provider Demographics
NPI:1548562648
Name:BOW, REAGAN
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:BOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RANCH ROAD 3237
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5311
Mailing Address - Country:US
Mailing Address - Phone:512-847-5540
Mailing Address - Fax:
Practice Address - Street 1:555 RANCH ROAD 3237
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5311
Practice Address - Country:US
Practice Address - Phone:512-847-5540
Practice Address - Fax:512-847-0419
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist