Provider Demographics
NPI:1760810154
Name:BOWEN, LINDA KATHELENE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KATHELENE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 N CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1011
Mailing Address - Country:US
Mailing Address - Phone:208-484-3017
Mailing Address - Fax:
Practice Address - Street 1:123 E 44TH ST STE A
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-5008
Practice Address - Country:US
Practice Address - Phone:208-484-3017
Practice Address - Fax:208-658-4827
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-345851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical