Provider Demographics
NPI:1104665207
Name:BOWLIN, MORGAN NICOLE (AUD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:NICOLE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1753 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3045
Mailing Address - Country:US
Mailing Address - Phone:208-524-4445
Mailing Address - Fax:208-522-5005
Practice Address - Street 1:1753 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3045
Practice Address - Country:US
Practice Address - Phone:208-524-4445
Practice Address - Fax:208-522-5005
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-6347231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist