Provider Demographics
NPI:1972836765
Name:BOZWELL, DANIEL E (HIS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:BOZWELL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CIRCLE WAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6602
Mailing Address - Country:US
Mailing Address - Phone:636-543-9500
Mailing Address - Fax:636-543-9500
Practice Address - Street 1:54 CIRCLE WAY DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6602
Practice Address - Country:US
Practice Address - Phone:636-543-9500
Practice Address - Fax:636-543-9500
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHISIT 2009019599237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist