Provider Demographics
NPI:1841072964
Name:BOWSER, REGINALD JUSTIN (PEER RECOVERY)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:JUSTIN
Last Name:BOWSER
Suffix:
Gender:M
Credentials:PEER RECOVERY
Other - Prefix:
Other - First Name:REGINALD
Other - Middle Name:JUSTIN
Other - Last Name:BOWSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2225 MAPLEWOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 EASTON CMNS STE 125
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6223
Practice Address - Country:US
Practice Address - Phone:612-900-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004424175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist