Provider Demographics
NPI:1609024272
Name:BOWEN, STEPHANIE VINING
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VINING
Last Name:BOWEN
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 1:5625 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3816
Mailing Address - Country:US
Mailing Address - Phone:901-761-0147
Mailing Address - Fax:901-763-4332
Practice Address - Street 1:5625 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3816
Practice Address - Country:US
Practice Address - Phone:901-761-0147
Practice Address - Fax:901-763-4332
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001256231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist