Provider Demographics
NPI:1861643918
Name:BOWLIN, KIM (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:BOWLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:300 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3651
Mailing Address - Country:US
Mailing Address - Phone:585-966-4947
Mailing Address - Fax:
Practice Address - Street 1:300 HOLMES RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3651
Practice Address - Country:US
Practice Address - Phone:585-966-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0081581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist