MEDICARE: MRS. JEANNIE V BOWERS CDPT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	60514851	WA

General Provider Information

NPI Number	:	1649751637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNIE V BOWERS CDPT

Provider Business Mailing Address
First Line	:	401 BALLARAT AVE N
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8191
Country	:	US
Telephone Number	:	425-888-4151
Fax Number	:	425-888-1064

Provider Business Practice Location Address
First Line	:	401 BALLARAT AVE N
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8191
Country	:	US
Telephone Number	:	425-888-4151
Fax Number	:	425-888-1064

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/27/2018

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