Provider Demographics
NPI:1780069203
Name:BOWES, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BOWES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 NESTLING RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1609
Mailing Address - Country:US
Mailing Address - Phone:267-808-4796
Mailing Address - Fax:
Practice Address - Street 1:2821 NESTLING RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1609
Practice Address - Country:US
Practice Address - Phone:267-808-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-26
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL009025OtherSPEECH LANGUAGE PATHOLOGY LICENSE
CASP 22170OtherSPEECH LANGUAGE PATHOLOGY LICENSE
WALL60486309OtherSPEECH LANGUAGE PATHOLOGY LICENSE