Healthcare Provider Details

I. General information

NPI: 1972694206
Provider Name (Legal Business Name): KAREN MARIE BOWERSOX PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN MARIE ZYGOWICZ PHD

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E BENNETT ST STE 209
SALINE MI
48176-1659
US

IV. Provider business mailing address

135 E BENNETT ST STE 209
SALINE MI
48176-1659
US

V. Phone/Fax

Practice location:
  • Phone: 734-474-0428
  • Fax: 734-418-9612
Mailing address:
  • Phone: 734-474-0428
  • Fax: 734-418-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2730-057
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2730-057
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301014461
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301014461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: