Healthcare Provider Details

I. General information

NPI: 1356756696
Provider Name (Legal Business Name): HAYLEY BOWEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 08/15/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N MILWAUKEE ST SUITE 208
MILWAUKEE WI
53202-5885
US

IV. Provider business mailing address

2345 FALKIRK DR
COLORADO SPRINGS CO
80910-2186
US

V. Phone/Fax

Practice location:
  • Phone: 414-615-0665
  • Fax: 414-615-0667
Mailing address:
  • Phone: 719-465-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1020
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-118063
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: