Healthcare Provider Details

I. General information

NPI: 1740431196
Provider Name (Legal Business Name): ANDREW GREGORY BOWERS SLP-CCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N. LA PAZ ST.
DEWEY AZ
86327
US

IV. Provider business mailing address

422 N LA PAZ ST
DEWEY AZ
86327-7147
US

V. Phone/Fax

Practice location:
  • Phone: 928-899-0374
  • Fax: 928-277-0790
Mailing address:
  • Phone: 928-899-0374
  • Fax: 928-277-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-5433
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: