Healthcare Provider Details

I. General information

NPI: 1821324880
Provider Name (Legal Business Name): MR. DAVID MICHAEL BOWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W WHITE ST
CLINTON IL
61727-2272
US

IV. Provider business mailing address

422 W WHITE ST
CLINTON IL
61727-2272
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-9571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180003268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: