Healthcare Provider Details

I. General information

NPI: 1447245485
Provider Name (Legal Business Name): MARIANNE G BOWDEN PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 RIFFEL RD SUITE B
WOOSTER OH
44691-8592
US

IV. Provider business mailing address

365 RIFFEL RD SUITE B
WOOSTER OH
44691-8592
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-3461
  • Fax: 330-345-3462
Mailing address:
  • Phone: 330-345-3461
  • Fax: 330-345-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5038
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBORA K JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-345-3461