Provider Demographics
NPI:1134402191
Name:BOWMAN, SELECE WIGGINS (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SELECE
Middle Name:WIGGINS
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CHALBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-9001
Mailing Address - Country:US
Mailing Address - Phone:757-477-3661
Mailing Address - Fax:757-482-9655
Practice Address - Street 1:801 CHALBOURNE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-9001
Practice Address - Country:US
Practice Address - Phone:757-477-3661
Practice Address - Fax:757-482-9655
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist