Individual
JADA BOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1121 MARIGOLD DR. NE, ALBUQUERQUE, NM 87122-1112
(505) 280-7276
Mailing address
1121 MARIGOLD DR NE, ALBUQUERQUE, NM 87122-1112
(505) 280-7276
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
286262
NM
252Y00000X
Early Intervention Provider Agency
02734408
TX
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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