Healthcare Provider Details

I. General information

NPI: 1952853228
Provider Name (Legal Business Name): CHERYL ANNE BOWMAN MSW, APSW, SAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVE
MARINETTE WI
54143-1655
US

IV. Provider business mailing address

2500 HALL AVE
MARINETTE WI
54143-1655
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-7760
  • Fax: 715-732-7711
Mailing address:
  • Phone: 715-732-7760
  • Fax: 715-732-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134840121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO 60634541
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: