Provider Demographics
NPI:1124528153
Name:GOWDY, IVANA D (RBT)
Entity type:Individual
Prefix:MISS
First Name:IVANA
Middle Name:D
Last Name:GOWDY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 N POWERS DR APT 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3274
Mailing Address - Country:US
Mailing Address - Phone:407-485-2942
Mailing Address - Fax:
Practice Address - Street 1:3024 N POWERS DR APT 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3274
Practice Address - Country:US
Practice Address - Phone:407-485-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty