Provider Demographics
NPI:1962637033
Name:BOWMAN, CRAIG W (LCSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NE 16TH AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4408
Mailing Address - Country:US
Mailing Address - Phone:510-541-5311
Mailing Address - Fax:
Practice Address - Street 1:1675 SW MARLOW AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5102
Practice Address - Country:US
Practice Address - Phone:503-297-7979
Practice Address - Fax:503-297-7980
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW25164104100000X
ORL73151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500735648Medicaid
WA2107172Medicaid