Provider Demographics
NPI:1740828045
Name:BOWRING, STEPHANIE M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:BOWRING
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 BOYDTON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841-2449
Mailing Address - Country:US
Mailing Address - Phone:617-763-7103
Mailing Address - Fax:
Practice Address - Street 1:13811 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841-2449
Practice Address - Country:US
Practice Address - Phone:804-469-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist