Provider Demographics
NPI:1942555628
Name:BOWMAN, ERIN R (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:R
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770-0283
Mailing Address - Country:US
Mailing Address - Phone:765-215-1736
Mailing Address - Fax:
Practice Address - Street 1:9910 DUPONT CIRCLE DR E STE 140
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1618
Practice Address - Country:US
Practice Address - Phone:260-570-4515
Practice Address - Fax:260-206-0762
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042505A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201094690Medicaid
IN20042505AOtherINDIANA PSYCHOLOGIST LICENSE