Provider Demographics
NPI:1801947197
Name:BOWEN, SHIRLEY HOUSE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:HOUSE
Last Name:BOWEN
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 1:1913 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-2922
Mailing Address - Country:US
Mailing Address - Phone:252-531-9009
Mailing Address - Fax:252-758-9465
Practice Address - Street 1:1913 E 9TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2922
Practice Address - Country:US
Practice Address - Phone:252-531-9009
Practice Address - Fax:252-758-9465
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412012Medicaid