Healthcare Provider Details

I. General information

NPI: 1144351578
Provider Name (Legal Business Name): ALEX R BOWMAN ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BALDWIN ST
ARCATA CA
95521-5168
US

IV. Provider business mailing address

1435 BUTTERMILK LN
ARCATA CA
95521-6909
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-4858
  • Fax: 707-822-6419
Mailing address:
  • Phone: 707-822-0351
  • Fax: 707-822-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: