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General NPI Number Information
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NPI Number | 1982518007
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Entity Type | Individual
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Provider Name | JACK BOWEN
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Gender | Male
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 23309 N 17TH DR
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City | PHOENIX
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State | AZ
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Zip | 85027-6305
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Country | US
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Telephone | 602-641-2464
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Fax |
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Provider Business Mailing Address
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Address Line | 23309 N 17TH DR STE 100
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City | PHOENIX
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State | AZ
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Zip | 85027-6306
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Country | US
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Telephone | 602-641-2464
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-407532
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License Number State | AZ
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