Healthcare Provider Details

I. General information

NPI: 1053551416
Provider Name (Legal Business Name): MARY KATHLEEN BOWER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE 7TH ST
GRESHAM OR
97030-5604
US

IV. Provider business mailing address

400 NE 7TH ST
GRESHAM OR
97030-5604
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-5455
  • Fax: 503-661-4959
Mailing address:
  • Phone: 503-661-5455
  • Fax: 503-661-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: