Provider Demographics
NPI:1992309090
Name:BOWEN, JARRETT (BCBA)
Entity type:Individual
Prefix:
First Name:JARRETT
Middle Name:
Last Name:BOWEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 STARKEY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-1685
Mailing Address - Country:US
Mailing Address - Phone:765-603-7704
Mailing Address - Fax:
Practice Address - Street 1:4915 W BURREL LN
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8023
Practice Address - Country:US
Practice Address - Phone:888-877-7111
Practice Address - Fax:317-978-3478
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-18-64696106S00000X
IN1-22-60147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician