Provider Demographics
NPI:1174928006
Name:BOWMAN, COLLEEN (MSED (BIRTH-2 SPED))
Entity type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MSED (BIRTH-2 SPED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4502
Mailing Address - Country:US
Mailing Address - Phone:631-766-1992
Mailing Address - Fax:
Practice Address - Street 1:36 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4502
Practice Address - Country:US
Practice Address - Phone:631-766-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY342302406252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency