Provider Demographics
NPI:1023289485
Name:ABBY BOWEN-RODDA PH.D., PC
Entity type:Organization
Organization Name:ABBY BOWEN-RODDA PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN-RODDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-577-4247
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:STE 107
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 107
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty