Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PPC-1241 | WY |
NPI | 1003577875 |
---|---|
Provider Name | Stephanie Nicole Bowman |
First Address | Rawlins, WY 82301-5447 |
Second Address | Rawlins, WY 82301-5447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2022 |
Last Update Date | 04/01/2022 |