Provider Demographics
NPI:1245533363
Name:BOWMAN, TAMARA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 COLLIERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1865
Mailing Address - Country:US
Mailing Address - Phone:706-296-8876
Mailing Address - Fax:
Practice Address - Street 1:1070 COLLIERS CREEK RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1865
Practice Address - Country:US
Practice Address - Phone:706-296-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP001684OtherSTATE LICENSE