Provider Demographics
NPI:1659988657
Name:BOWEN, BROOKE N (HAD)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:N
Last Name:BOWEN
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-0354
Mailing Address - Country:US
Mailing Address - Phone:719-539-6566
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST STE 135
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-5011
Practice Address - Country:US
Practice Address - Phone:719-539-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000418237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist