Provider Demographics
NPI:1770635617
Name:BOWLING, SUZANNE MICHELLE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:PHD, 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:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1619
Mailing Address - Country:US
Mailing Address - Phone:270-577-3012
Mailing Address - Fax:270-826-8261
Practice Address - Street 1:503 FIFTH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3053
Practice Address - Country:US
Practice Address - Phone:270-577-3012
Practice Address - Fax:270-826-8261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002055A235Z00000X
KYKY1107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS96480Medicare UPIN
KYK09370Medicare UPIN