Provider Demographics
NPI:1134619778
Name:BOWMAN, KATELYN MAE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MAE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3505
Mailing Address - Country:US
Mailing Address - Phone:248-804-7357
Mailing Address - Fax:
Practice Address - Street 1:305 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2519
Practice Address - Country:US
Practice Address - Phone:248-804-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician