Provider Demographics
NPI:1770002230
Name:GOWER, NATALIE K (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:K
Last Name:GOWER
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 1:310 CARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1186
Mailing Address - Country:US
Mailing Address - Phone:217-433-0088
Mailing Address - Fax:
Practice Address - Street 1:88 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4473
Practice Address - Country:US
Practice Address - Phone:217-362-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist