Provider Demographics
NPI:1316729726
Name:BOWMAN, ALISA TUILESU (LMSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:TUILESU
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DEMERS AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4599
Mailing Address - Country:US
Mailing Address - Phone:701-757-0292
Mailing Address - Fax:
Practice Address - Street 1:600 DEMERS AVE STE 303
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4599
Practice Address - Country:US
Practice Address - Phone:701-757-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5654104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker