Provider Demographics
NPI:1487962882
Name:BOWLIN, MISTY ADAMS
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:ADAMS
Last Name:BOWLIN
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 1:3540 NE STALLINGS DR
Mailing Address - Street 2:SUITE # 311 & 312
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-8708
Mailing Address - Country:US
Mailing Address - Phone:936-564-0952
Mailing Address - Fax:
Practice Address - Street 1:3540 NE STALLINGS DR
Practice Address - Street 2:SUITE # 311 & 312
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-8708
Practice Address - Country:US
Practice Address - Phone:936-564-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist