Healthcare Provider Details

I. General information

NPI: 1649438136
Provider Name (Legal Business Name): ELIZABETH G. BOWDEN M.A. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 03/06/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5204 W REDBUD ST
ROGERS AR
72758-8936
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-0110
  • Fax: 479-631-0491
Mailing address:
  • Phone: 314-543-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA #94
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: