Provider Demographics
NPI:1477931400
Name:BOWEN, VANESSA (MA, LPC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 LANCASTER DR SE # 206
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5642
Mailing Address - Country:US
Mailing Address - Phone:971-388-4573
Mailing Address - Fax:
Practice Address - Street 1:1915 NE STUCKI AVE STE 400
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6938
Practice Address - Country:US
Practice Address - Phone:503-714-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC9978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional