Healthcare Provider Details

I. General information

NPI: 1548188717
Provider Name (Legal Business Name): GILLIAN ELAINE BOWMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 KNOX ABBOTT DR STE 111
CAYCE SC
29033-3346
US

IV. Provider business mailing address

989 KNOX ABBOTT DR STE 111
CAYCE SC
29033-3346
US

V. Phone/Fax

Practice location:
  • Phone: 803-768-9186
  • Fax:
Mailing address:
  • Phone: 803-768-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9746
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: