Provider Demographics
NPI:1366167413
Name:BOWSER, JESSICA (AMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BOWSER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 RING AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-4327
Mailing Address - Country:US
Mailing Address - Phone:443-481-7416
Mailing Address - Fax:
Practice Address - Street 1:10601 CIVIC CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7682
Practice Address - Country:US
Practice Address - Phone:909-293-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist