Provider Demographics
NPI:1528501277
Name:BOWMAN, MICAYLA (SLP)
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 STATE RD
Mailing Address - Street 2:SUIT 7
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5114
Mailing Address - Country:US
Mailing Address - Phone:781-603-8529
Mailing Address - Fax:
Practice Address - Street 1:488 STATE RD
Practice Address - Street 2:SUIT 7
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5114
Practice Address - Country:US
Practice Address - Phone:781-603-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist