Provider Demographics
NPI:1861767162
Name:BOWEN, EMILY (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11838 BERNARDO PLAZA CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2413
Mailing Address - Country:US
Mailing Address - Phone:858-673-5437
Mailing Address - Fax:858-673-5434
Practice Address - Street 1:11838 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2413
Practice Address - Country:US
Practice Address - Phone:858-673-5437
Practice Address - Fax:858-673-5434
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5035235Z00000X
CA23691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist