Provider Demographics
NPI:1558169565
Name:BOWLES, LUCILLE PEARL
Entity type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:PEARL
Last Name:BOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:PEARL
Other - Last Name:HARBOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2827
Mailing Address - Country:US
Mailing Address - Phone:321-338-2419
Mailing Address - Fax:321-301-4278
Practice Address - Street 1:107 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2827
Practice Address - Country:US
Practice Address - Phone:321-338-2419
Practice Address - Fax:321-301-4278
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI79732355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant