Individual
DR. SANDRA W BOWKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, ABPP
Contact information
Practice address
5148 LOVERS LN STE 2, PORTAGE, MI 49002-1572
(269) 343-3010
(269) 343-3017
Mailing address
5148 LOVERS LN STE 2, PORTAGE, MI 49002-1572
(269) 343-3010
(269) 343-3017
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301010557
MI
103TC0700X
Clinical Psychologist
6301010557
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C96409
BCBSM
MI
01
—
6130541
PHP
MI
Enumeration date
05/09/2006
Last updated
12/06/2015
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