MEDICARE: WYATT BOWLAND

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1730011024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYATT BOWLAND

Provider Business Mailing Address
First Line	:	901 CRESCENT DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-2716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 W JEFFERSON AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80235-2031
Country	:	US
Telephone Number	:	877-504-4141
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ WYATT BOWLAND ” Practice Location

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