Healthcare Provider Details

I. General information

NPI: 1821928466
Provider Name (Legal Business Name): BAILEY LYNN BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 DURANT ST
SOUTH HILL VA
23970-1614
US

IV. Provider business mailing address

2151 BOWEN RD
VIRGILINA VA
24598-3229
US

V. Phone/Fax

Practice location:
  • Phone: 434-584-9096
  • Fax:
Mailing address:
  • Phone: 434-222-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: