Healthcare Provider Details

I. General information

NPI: 1013702224
Provider Name (Legal Business Name): GLORY C BOWCASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 SW 74TH ST STE 109-115
OKLAHOMA CITY OK
73159-3931
US

IV. Provider business mailing address

2219 SW 74TH ST STE 109-115
OKLAHOMA CITY OK
73159-3931
US

V. Phone/Fax

Practice location:
  • Phone: 405-355-3239
  • Fax:
Mailing address:
  • Phone: 405-355-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA434
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: