Healthcare Provider Details

I. General information

NPI: 1396572095
Provider Name (Legal Business Name): ZOE BOWEN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 US HIGHWAY 93 S
KALISPELL MT
59901-8499
US

IV. Provider business mailing address

214 SPRUCE RD APT 11
KALISPELL MT
59901-3393
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-2570
  • Fax: 406-203-9949
Mailing address:
  • Phone: 406-314-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-72557
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: