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General NPI Number Information
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NPI Number | 1306491204
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Entity Type | Individual
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Provider Name | KELLY BOWERS LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 718 SMYTH RD
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City | MANCHESTER
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State | NH
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Zip | 03104-7007
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Country | US
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Telephone | 603-624-4366
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Fax |
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Provider Business Mailing Address
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Address Line | 718 SMYTH RD
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City | MANCHESTER
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State | NH
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Zip | 03104-7007
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Country | US
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Telephone | 603-624-4366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33008908A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LM14574
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License Number State | ME
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