Healthcare Provider Details

I. General information

NPI: 1871151258
Provider Name (Legal Business Name): DEVON ANTHONY BOWENS LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053
US

IV. Provider business mailing address

5702 WILLIAMSBURG DR
LORAIN OH
44053-3249
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-7232
  • Fax:
Mailing address:
  • Phone: 440-396-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2004694
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: