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Individual

CODY ASHTON RYAN BOWSER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
526 OLD LIVERPOOL RD STE 9, LIVERPOOL, NY 13088-6285
(315) 453-3911
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4523

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01420800
NY
Enumeration date
07/03/2019
Last updated
07/03/2019
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