Healthcare Provider Details

I. General information

NPI: 1093278848
Provider Name (Legal Business Name): JOSEPH LEVI BOWLES III M.S. CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12656 SHADOW RIDGE BLVD
HUDSON FL
34669-2791
US

IV. Provider business mailing address

12656 SHADOW RIDGE BLVD
HUDSON FL
34669-2791
US

V. Phone/Fax

Practice location:
  • Phone: 386-984-0206
  • Fax:
Mailing address:
  • Phone: 386-984-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP33833
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: