Individual
GARY L. BOWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
714 WASHINGTON AVE, DETROIT LAKES, MN 56501-3012
(218) 847-1676
(218) 847-1678
Mailing address
PO BOX 267, ORR, MN 55771-0267
(218) 847-1676
(218) 847-1678
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3287
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011908
PREFERREDONE
MN
01
—
110240
UCARE MINNESOTA
MN
01
—
366L4BO
BLUE CROSS/BLUE SHIELD
MN
01
—
61-53881
UNITED BEHAVIORAL HEALTH
MN
01
—
HP48979
HELATHPARTNERS
MN
Enumeration date
06/07/2006
Last updated
07/08/2007
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