Provider Demographics
NPI:1952709339
Name:BOWER, SHAWN (CRM)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BOWER
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 SE ROETHE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5645
Mailing Address - Country:US
Mailing Address - Phone:503-431-9182
Mailing Address - Fax:
Practice Address - Street 1:17763 SE 82ND DR STE D
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1822
Practice Address - Country:US
Practice Address - Phone:503-344-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-CRM-067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker