Provider Demographics
NPI:1730368754
Name:BOWMAN, JAN LESLIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:LESLIE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:LESLIE
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:19 GLENEDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4316
Mailing Address - Country:US
Mailing Address - Phone:510-594-9569
Mailing Address - Fax:415-771-4395
Practice Address - Street 1:19 GLENEDEN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4316
Practice Address - Country:US
Practice Address - Phone:510-594-9569
Practice Address - Fax:415-771-4395
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12631103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical