Provider Demographics
NPI:1801238993
Name:BOWLING, JANE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:MARIE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2028
Mailing Address - Country:US
Mailing Address - Phone:502-417-4921
Mailing Address - Fax:502-899-7625
Practice Address - Street 1:2021 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2028
Practice Address - Country:US
Practice Address - Phone:502-417-4921
Practice Address - Fax:502-899-7625
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128156103TC0700X
KY1005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical