Jan Leslie Bowman, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY12631 Issued in CA

Practice address

19 Gleneden Ave
Oakland, CA 94611-4316

Phone

(510) 594-9569

Fax

(415) 771-4395

NPI assigned

Oct 26, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jan Leslie Grayson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 10, 2024 through May 10, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1730368754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 GLENEDEN AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946114316",
            "telephone_number": "510-594-9569",
            "fax_number": "415-771-4395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 GLENEDEN AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946114316",
            "telephone_number": "510-594-9569",
            "fax_number": "415-771-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "JAN",
        "middle_name": "LESLIE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY12631",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12631",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAN",
            "last_name": "GRAYSON",
            "middle_name": "LESLIE",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Bowley, MSW
• Sandra Kathleen Bowling, MA
• Andre B Bowman
• Emily Rose Bowman
• Gena Sharon Bowman, MSW, INTERN
• Jennifer Bowman
• Monica Bowman
• Katya Bownas
• Leah Bowser, MD
• Denique Boxhill

• Psychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.