Healthcare Provider Details

I. General information

NPI: 1922510791
Provider Name (Legal Business Name): JESSICA MARIE BOWMAN LLP, CIC-CPP, C-DBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31129 PLYMOUTH RD
LIVONIA MI
48150-2103
US

IV. Provider business mailing address

17 E ELM AVE APT 5
MONROE MI
48162-2684
US

V. Phone/Fax

Practice location:
  • Phone: 734-890-9113
  • Fax:
Mailing address:
  • Phone: 313-778-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6361008001
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6361008001
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6361008001
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361008001
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6361008001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: