Active NPI
Jill M Bowen, SLP
- Speech-Language Pathologist
- Lackawanna, NY
National Provider Identifier
1720364359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 0104141
- Practice address
- 15 Inner Dr
Lackawanna, NY 14218-3626 - Phone
- (716) 827-6741
- NPI assigned
- Oct 27, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 0104141 | NY | Primary |
Addresses
Primary practice location
15 Inner Dr
Lackawanna, NY 14218-3626
Mailing address
15 Inner Dr
Lackawanna, NY 14218-3626
Phone (716) 827-6741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01368996 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0104141 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1720364359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 INNER DR",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142183626",
"telephone_number": "716-827-6741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 INNER DR",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142183626",
"telephone_number": "716-827-6741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWEN",
"first_name": "JILL",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-27",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "0104141",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01368996",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lackawanna, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.