Healthcare Provider Details

I. General information

NPI: 1063833010
Provider Name (Legal Business Name): JESSICA BOWEN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 REGIONAL DR STE 7
CONCORD NH
03301-8518
US

IV. Provider business mailing address

PO BOX 406
MILTON NH
03851-0406
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1518
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP2276
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: