Healthcare Provider Details

I. General information

NPI: 1093911505
Provider Name (Legal Business Name): JENNIFER BOWDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GOLDEN OAK TRL SE
ALTO MI
49302-9353
US

IV. Provider business mailing address

UNIT 401 11525 KIRBY ST SE
ALTO MI
49302-5103
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9824
  • Fax: 616-236-0874
Mailing address:
  • Phone: 616-591-9824
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301111313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: