Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34005318A | IN |
NPI | 1003030453 |
---|---|
Provider Name | Amy Bowman |
First Address | Chesterton, IN 46304-2457 |
Second Address | Chesterton, IN 46304-2457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |