Provider Demographics
NPI:1629657036
Name:BOWERSOX, TALAYNA
Entity Type:Individual
Prefix:
First Name:TALAYNA
Middle Name:
Last Name:BOWERSOX
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 1:319 PEFFER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-1834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4309 LINGLESTOWN RD STE 214
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8607
Practice Address - Country:US
Practice Address - Phone:717-412-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker