Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 071005436 | IL |
Y | 103TC0700X | Clinical Psychologist | 071005436 | IL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1457421810 |
---|---|
Provider Name | Dr. Dennis R Bowling |
First Address | Wichita, KS 67218-1607 |
Second Address | Wichita, KS 67218-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 03/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02220198 | BLUE CROSS BLUE SHIELD (01) | IL |
1043857 | CIGNA (01) | IL |
206272 | MANAGED HEALTH NETWORK (01) | IL |
208124 | (02) | IL |