Provider Demographics
NPI:1598387300
Name:BOWSER, SHELBY LYNN (CRC, LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:BOWSER
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:LYNN
Other - Last Name:JURGENSMIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4785 HAYES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7364
Mailing Address - Country:US
Mailing Address - Phone:608-242-7160
Mailing Address - Fax:608-242-7153
Practice Address - Street 1:4785 HAYES RD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7364
Practice Address - Country:US
Practice Address - Phone:608-242-7160
Practice Address - Fax:608-242-7153
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7829-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional