Provider Demographics
NPI:1578712972
Name:BOVEN, DAWN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:
Last Name:BOVEN
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 1:326 W WATERLOO ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1064
Mailing Address - Country:US
Mailing Address - Phone:231-250-0939
Mailing Address - Fax:
Practice Address - Street 1:745 WATER TOWER RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2135
Practice Address - Country:US
Practice Address - Phone:231-592-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12072932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist