Healthcare Provider Details

I. General information

NPI: 1053895649
Provider Name (Legal Business Name): ASPEN BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36012 N MILAN ELK RD
CHATTAROY WA
99003-8610
US

IV. Provider business mailing address

36012 N MILAN ELK RD
CHATTAROY WA
99003-8610
US

V. Phone/Fax

Practice location:
  • Phone: 509-306-0086
  • Fax:
Mailing address:
  • Phone: 509-306-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: