Provider Demographics
NPI:1669616926
Name:BOWNE, VANESSA AYE (SLP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:AYE
Last Name:BOWNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:AYE
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:905 WOODMONT LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1264
Mailing Address - Country:US
Mailing Address - Phone:305-905-2289
Mailing Address - Fax:
Practice Address - Street 1:905 WOODMONT LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1264
Practice Address - Country:US
Practice Address - Phone:305-905-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4683235Z00000X
FLSA10066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist