Healthcare Provider Details

I. General information

NPI: 1396026241
Provider Name (Legal Business Name): TRISSI BOWLIN B.A, H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 W NORTHWEST HWY
DALLAS TX
75225-4202
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8123
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-5466
  • Fax: 214-691-7250
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: