Provider Demographics
NPI:1558758086
Name:BOWEN, JENNA (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 ODANA RD # 173
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1012
Mailing Address - Country:US
Mailing Address - Phone:925-608-8700
Mailing Address - Fax:
Practice Address - Street 1:6666 ODANA RD # 173
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1012
Practice Address - Country:US
Practice Address - Phone:925-608-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1716512084P0800X, 2084P0804X
WI57692084P0800X
WA608295532084P0800X, 2084P0804X
WI675232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry