Provider Demographics
NPI:1649637380
Name:BOWYER LCSW, JENNIE R (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIE R
Middle Name:
Last Name:BOWYER LCSW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 STATE ROAD 69
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-9328
Mailing Address - Country:US
Mailing Address - Phone:608-527-2401
Mailing Address - Fax:608-527-2401
Practice Address - Street 1:1307 STATE ROAD 69
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9328
Practice Address - Country:US
Practice Address - Phone:608-921-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8897-123101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health