Provider Demographics
NPI:1740431196
Name:BOWERS, ANDREW GREGORY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GREGORY
Last Name:BOWERS
Suffix:
Gender:M
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N LA PAZ ST
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-7147
Mailing Address - Country:US
Mailing Address - Phone:928-899-0374
Mailing Address - Fax:928-277-0790
Practice Address - Street 1:422 N. LA PAZ ST.
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327
Practice Address - Country:US
Practice Address - Phone:928-899-0374
Practice Address - Fax:928-277-0790
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP-5433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP-5433OtherADHS