Provider Demographics
NPI:1588961965
Name:BOWE, REBECCA (BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOWE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6964
Mailing Address - Country:US
Mailing Address - Phone:816-804-1704
Mailing Address - Fax:
Practice Address - Street 1:601 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6964
Practice Address - Country:US
Practice Address - Phone:816-804-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856271408Medicaid