Provider Demographics
NPI:1063579969
Name:BOWMAN, JENNIFER T
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PATRICE
Other - Last Name:TOMLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:188-833-3915
Mailing Address - Fax:763-268-4353
Practice Address - Street 1:11390 SE 82ND AVE
Practice Address - Street 2:STE 801
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-7637
Practice Address - Country:US
Practice Address - Phone:503-653-5004
Practice Address - Fax:503-794-0531
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023305231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist