Provider Demographics
NPI:1609021369
Name:SANDRA BOWKER AND ASSOCIATES, PLC
Entity type:Organization
Organization Name:SANDRA BOWKER AND ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:269-343-3010
Mailing Address - Street 1:5930 LOVERS LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1673
Mailing Address - Country:US
Mailing Address - Phone:269-343-3010
Mailing Address - Fax:269-343-3017
Practice Address - Street 1:5930 LOVERS LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1673
Practice Address - Country:US
Practice Address - Phone:269-343-3010
Practice Address - Fax:269-343-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty