Provider Demographics
NPI:1588896617
Name:BOWMAN, CARRIE MAE (MS, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MAE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:MAE
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:FULTONHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12071-0056
Mailing Address - Country:US
Mailing Address - Phone:518-827-8223
Mailing Address - Fax:
Practice Address - Street 1:3460 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:FULTONHAM
Practice Address - State:NY
Practice Address - Zip Code:12071-0056
Practice Address - Country:US
Practice Address - Phone:518-827-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013841235Z00000X
TX104200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist