Provider Demographics
NPI:1972694206
Name:BOWERSOX, KAREN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:BOWERSOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:ZYGOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:135 E BENNETT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1659
Mailing Address - Country:US
Mailing Address - Phone:734-474-0428
Mailing Address - Fax:734-418-9612
Practice Address - Street 1:135 E BENNETT ST STE 209
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1659
Practice Address - Country:US
Practice Address - Phone:734-474-0428
Practice Address - Fax:734-418-9612
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2730-057103TA0400X, 103T00000X
MI6301014461103TA0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)