Provider Demographics
NPI:1699065284
Name:BOWLEN, DIANNA KAY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:KAY
Last Name:BOWLEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:KAY
Other - Last Name:KINGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:51577 SE 2ND ST APT 1203
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-4562
Mailing Address - Country:US
Mailing Address - Phone:503-997-7734
Mailing Address - Fax:
Practice Address - Street 1:51577 SE 2ND ST APT 1203
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-4562
Practice Address - Country:US
Practice Address - Phone:503-997-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL32231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical