MEDICARE: DESTINY BOWEN

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

General Provider Information

NPI Number	:	1437936424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY BOWEN

Provider Business Mailing Address
First Line	:	3807 THOMAS RD SW APT 4
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 WESTMILL DR SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-6119
Country	:	US
Telephone Number	:	256-382-2590
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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Directions to “ DESTINY BOWEN ” Practice Location

Language	Start Address	Practice Location

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