Provider Demographics
NPI:1588059117
Name:BOWMAN, MADELAINE (MA, MED, BCBA)
Entity type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MA, MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E 400 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2838
Mailing Address - Country:US
Mailing Address - Phone:208-403-7330
Mailing Address - Fax:
Practice Address - Street 1:243 E 400 S
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2838
Practice Address - Country:US
Practice Address - Phone:208-403-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst