Provider Demographics
NPI:1902672074
Name:BOWEN-GRAHAM, OLEN FOSS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLEN
Middle Name:FOSS
Last Name:BOWEN-GRAHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:GRAHAM
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E EISENHOWER PKWY BLDG 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3302
Mailing Address - Country:US
Mailing Address - Phone:734-232-3270
Mailing Address - Fax:
Practice Address - Street 1:400 E EISENHOWER PKWY BLDG 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3302
Practice Address - Country:US
Practice Address - Phone:734-232-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist