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NPI Code Detail

MEDICARE: MISS JORDAN JANE BOWMAN MA CCC-SLP

MEDICARE: MISS JORDAN JANE BOWMAN MA CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2202005463VA
2235Z00000XSpeech-Language Pathologist2202005863VA

General Provider Information

NPI Number : 1497033757
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JORDAN JANE BOWMAN MA CCC-SLP
Provider Business Mailing Address
First Line : 1102 WEST AVE
Second Line : APARTMENT 3
City : RICHMOND
State : VA
Zip : 23220-3725
Country : US
Telephone Number : 614-370-7395
Fax Number :
Provider Business Practice Location Address
First Line : 5905 W WASHINGTON BLVD
Second Line : GENESIS REHAB-MAYFIELD CARE CENTRE
City : CHICAGO
State : IL
Zip : 60644-2845
Country : US
Telephone Number : 773-261-7074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2011
Last Update Date : 03/29/2012

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