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General NPI Number Information
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NPI Number | 1336412048
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Entity Type | Individual
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Provider Name | MARY BETH BOWEN
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Gender | Female
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 1615 BROWN AVE SUITE 2A
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City | COOKEVILLE
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State | TN
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Zip | 38501-1445
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Country | US
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Telephone | 931-510-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 652 MACKIE RD
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City | SPARTA
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State | TN
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Zip | 38583-5793
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Country | US
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Telephone | 931-510-1095
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4180
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License Number State | TN
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