Provider Demographics
NPI:1386372886
Name:BOWMAN, ELYSE
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 SW CASCADE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7126
Mailing Address - Country:US
Mailing Address - Phone:877-755-8940
Mailing Address - Fax:
Practice Address - Street 1:215 NE EDGEWAY DR APT 307
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-3665
Practice Address - Country:US
Practice Address - Phone:630-689-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty