Provider Demographics
NPI:1447456645
Name:JUDIE BOWMAN, PHD
Entity type:Organization
Organization Name:JUDIE BOWMAN, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-939-8828
Mailing Address - Street 1:5526 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9107
Mailing Address - Country:US
Mailing Address - Phone:719-930-8828
Mailing Address - Fax:719-687-8182
Practice Address - Street 1:801 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5927
Practice Address - Country:US
Practice Address - Phone:719-930-8828
Practice Address - Fax:719-687-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07020712Medicaid
CO07020712Medicaid