MEDICARE: STEPHANIE BOWDLER MHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063178101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BOWDLER MHP

Provider Business Mailing Address
First Line	:	21479 N TOLLE LN
Second Line	:
City	:	TEXICO
State	:	IL
Zip	:	62889-3012
Country	:	US
Telephone Number	:	618-322-5237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E MCCORD ST
Second Line	:
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3702
Country	:	US
Telephone Number	:	618-532-4311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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