Provider Demographics
NPI:1568875623
Name:BOWLAND, REBEKAH
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:BOWLAND
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 1:1417 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-9754
Mailing Address - Country:US
Mailing Address - Phone:717-661-3548
Mailing Address - Fax:717-656-3056
Practice Address - Street 1:1417 OREGON RD
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-9754
Practice Address - Country:US
Practice Address - Phone:717-661-3548
Practice Address - Fax:717-656-3056
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130640104100000X
PACW0229121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker