Provider Demographics
NPI:1104814649
Name:BOWDEN, MARIANNE G (PHD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:G
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 RIFFEL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8592
Mailing Address - Country:US
Mailing Address - Phone:330-345-3461
Mailing Address - Fax:330-345-3462
Practice Address - Street 1:365 RIFFEL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8592
Practice Address - Country:US
Practice Address - Phone:330-345-3461
Practice Address - Fax:330-345-3462
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2177040Medicaid
OH113526OtherMANAGED HEALTH NETWORK
OH113526OtherMANAGED HEALTH NETWORK
OH113526OtherMANAGED HEALTH NETWORK
OHMA9327471Medicare ID - Type Unspecified