1740431196 NPI number — ANDREW GREGORY BOWERS SLP-CCC

Table of content: ANDREW GREGORY BOWERS SLP-CCC (NPI 1740431196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740431196 NPI number — ANDREW GREGORY BOWERS SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWERS
Provider First Name:
ANDREW
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP-CCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740431196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 N LA PAZ ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEWEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86327-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-899-0374
Provider Business Mailing Address Fax Number:
928-277-0790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 N. LA PAZ ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEWEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-899-0374
Provider Business Practice Location Address Fax Number:
928-277-0790
Provider Enumeration Date:
10/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP-5433 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SLP-5433 . This is a "ADHS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".