Provider Demographics
NPI:1760899199
Name:BOWLIN-JOHNSON, JO
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:BOWLIN-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:BOWLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-0350
Mailing Address - Country:US
Mailing Address - Phone:425-358-0956
Mailing Address - Fax:877-481-6931
Practice Address - Street 1:11516 SE MILL PLAIN BLVD
Practice Address - Street 2:STE. J-2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5005
Practice Address - Country:US
Practice Address - Phone:360-882-8027
Practice Address - Fax:360-882-8030
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD 60155983237600000X
OR30790237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038850Medicaid
OR500675781Medicaid
WA2038850Medicaid
WAG8931401Medicare PIN