Provider Demographics
NPI:1316383250
Name:BOWERS, JANAYA MARIE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JANAYA
Middle Name:MARIE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18314 EASTWYCK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3175
Mailing Address - Country:US
Mailing Address - Phone:719-492-6849
Mailing Address - Fax:
Practice Address - Street 1:18314 EASTWYCK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3175
Practice Address - Country:US
Practice Address - Phone:719-492-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12154982235Z00000X
FLSA12957235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012017800Medicaid
FL014322200Medicaid