Healthcare Provider Details

I. General information

NPI: 1629199849
Provider Name (Legal Business Name): WESLEY ROLAND BOWMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 LANCASTER PIKE
WILMINGTON DE
19805-1509
US

IV. Provider business mailing address

3608 LANCASTER PIKE
WILMINGTON DE
19805-1509
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-9600
  • Fax: 302-995-9571
Mailing address:
  • Phone: 302-995-9600
  • Fax: 302-995-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB10000161
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: