Provider Demographics
NPI:1013060193
Name:BOWEN-RODDA, ABBY (PHD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:
Last Name:BOWEN-RODDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:STE 214
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-577-4247
Mailing Address - Fax:307-577-4249
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:STE 214
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-577-4247
Practice Address - Fax:307-577-4249
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW-303346Medicare ID - Type UnspecifiedPROVIDER NUMBER