Provider Demographics
NPI:1922317841
Name:BOUWIE, ERICA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:BOUWIE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:3331 STEEPLECHASE LN
Mailing Address - Street 2:#2D
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-3258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3331 STEEPLECHASE LN
Practice Address - Street 2:#2D
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-3258
Practice Address - Country:US
Practice Address - Phone:785-840-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3105819103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool