MEDICARE: AMANDA BOWLIN 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
1	1041C0700X	Clinical Social Worker	2014032116	MO

General Provider Information

NPI Number	:	1407446958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BOWLIN LCSW

Provider Business Mailing Address
First Line	:	10820 SUNSET OFFICE DR STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-502-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	10820 SUNSET OFFICE DR STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-502-9243
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	06/20/2024

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