Provider Demographics
NPI:1649751637
Name:BOWERS, JEANNIE V (CDPT)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:V
Last Name:BOWERS
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:MISS
Other - First Name:JEANNIE
Other - Middle Name:V
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 BALLARAT AVE N
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8191
Mailing Address - Country:US
Mailing Address - Phone:425-888-4151
Mailing Address - Fax:425-888-1064
Practice Address - Street 1:401 BALLARAT AVE N
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8191
Practice Address - Country:US
Practice Address - Phone:425-888-4151
Practice Address - Fax:425-888-1064
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60514851101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)