Healthcare Provider Details

I. General information

NPI: 1417050600
Provider Name (Legal Business Name): JUDIT NEMETH BOWLING PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JUDIT NEMETH

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 ROYAL AVE STE C
MEDFORD OR
97504-6121
US

IV. Provider business mailing address

PO BOX 503010
WHITE CITY OR
97503-0813
US

V. Phone/Fax

Practice location:
  • Phone: 541-941-5557
  • Fax: 503-419-4662
Mailing address:
  • Phone: 541-941-7792
  • Fax: 503-419-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberOBPE2181
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: