Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1003079005 |
---|---|
Provider Name | Breana S Bowsher |
First Address | Goshen, IN 46527-0809 |
Second Address | South Bend, IN 46617-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 15/03/2012 |