Healthcare Provider Details

I. General information

NPI: 1649899618
Provider Name (Legal Business Name): JONNI ROSE LUKENBILL-BOWLES MS, LPC, NCC, BCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E POLK ST
WASHINGTON IA
52353-1237
US

IV. Provider business mailing address

445 W 18TH ST
WASHINGTON IA
52353-4717
US

V. Phone/Fax

Practice location:
  • Phone: 319-653-2930
  • Fax:
Mailing address:
  • Phone: 847-254-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: