Individual
ANNAELISE BOWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
561 RIDGECREST RD, FORNEY, TX 75126-0146
(972) 552-2420
Mailing address
13301 GALLERIA PL, FARMERS BRANCH, TX 75244-6302
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
111147
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111147
111147
—
01
—
NA
NA
—
Enumeration date
02/16/2018
Last updated
12/19/2018
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