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NPI Code Detail

MEDICARE: JESSICA A. BOWMAN LCSW

MEDICARE: JESSICA A. BOWMAN LCSW
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
11041C0700XClinical Social Worker8844-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1130094-121OTHERWIAPSW - WISCONSIN STATE BOARD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144770959
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA A. BOWMAN LCSW
Provider Business Mailing Address
First Line : 571 COUNTY ROAD A
Second Line :
City : GREEN LAKE
State : WI
Zip : 54941-8630
Country : US
Telephone Number : 920-294-4070
Fax Number : 920-294-4139
Provider Business Practice Location Address
First Line : 571 COUNTY ROAD A
Second Line :
City : GREEN LAKE
State : WI
Zip : 54941-8630
Country : US
Telephone Number : 920-294-4070
Fax Number : 920-294-4139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2016
Last Update Date : 05/22/2019

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