Provider Demographics
NPI:1578170700
Name:BOWLDS, KAYLEIGH BROOKE
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:BROOKE
Last Name:BOWLDS
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 1:1663 N MERION WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6586
Mailing Address - Country:US
Mailing Address - Phone:270-993-0330
Mailing Address - Fax:
Practice Address - Street 1:1149 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-5837
Practice Address - Country:US
Practice Address - Phone:479-636-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AR201266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist