Provider Demographics
NPI:1689814709
Name:BOWMAN, JESSICA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-8826
Mailing Address - Country:US
Mailing Address - Phone:870-687-3503
Mailing Address - Fax:
Practice Address - Street 1:100 OAK AVE
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720-8826
Practice Address - Country:US
Practice Address - Phone:870-687-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24777235Z00000X
ARSP#3175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
AR193377721Medicaid
TX456554Medicare PIN