Provider Demographics
NPI:1902590409
Name:BOWEN, ALICIA R
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:BOWEN
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 1:3665 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2445
Mailing Address - Country:US
Mailing Address - Phone:989-799-6542
Mailing Address - Fax:989-799-6681
Practice Address - Street 1:1553 N 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9795
Practice Address - Country:US
Practice Address - Phone:989-430-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator