Provider Demographics
NPI:1598264343
Name:BOWMAN, JORDAN (BCBA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5269 WORTHY WAY APT 3312
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7499
Mailing Address - Country:US
Mailing Address - Phone:469-337-6318
Mailing Address - Fax:
Practice Address - Street 1:5269 WORTHY WAY APT 3312
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-7499
Practice Address - Country:US
Practice Address - Phone:469-337-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-16-22225106S00000X
TX4237103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician