Provider Demographics
NPI:1003307729
Name:BOWEN, DREA MARIE I (LMSW)
Entity type:Individual
Prefix:
First Name:DREA
Middle Name:MARIE
Last Name:BOWEN
Suffix:I
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DREA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S GREENSFERRY RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9590
Mailing Address - Country:US
Mailing Address - Phone:817-412-0062
Mailing Address - Fax:
Practice Address - Street 1:505 S GREENSFERRY RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9590
Practice Address - Country:US
Practice Address - Phone:817-412-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty