Provider Demographics
NPI:1285872135
Name:BOWDEN, PAUL BRENDAN (MACCC-SLP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRENDAN
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WINDMILL CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2238
Mailing Address - Country:US
Mailing Address - Phone:516-220-9915
Mailing Address - Fax:
Practice Address - Street 1:250 MACUS BVD
Practice Address - Street 2:
Practice Address - City:HAPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-232-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist