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General NPI Number Information
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NPI Number | 1447456645
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Entity Type | Organization
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Legal Business Name | JUDIE BOWMAN, PHD
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 801 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-5927
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Country | US
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Telephone | 719-930-8828
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Fax | 719-687-8182
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Provider Business Mailing Address
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Address Line | 5526 COUNTY ROAD 5
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City | DIVIDE
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State | CO
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Zip | 80814-9107
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Country | US
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Telephone | 719-930-8828
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Fax | 719-687-8182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUDIE BOWMAN
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Credential | PHD
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Telephone | 719-939-8828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2071
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License Number State | CO
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