Healthcare Provider Details

I. General information

NPI: 1548196116
Provider Name (Legal Business Name): ALYSSA JOY WADE-BOWEN CTRS, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

1017 APPLECROSS DR
LEXINGTON KY
40511-8980
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-595-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number84205
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: