Provider Demographics
NPI:1871734327
Name:BOWER, BRUCE EDWARD (MA, MSW, LMSW, DCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:BOWER
Suffix:
Gender:M
Credentials:MA, MSW, LMSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-1152
Mailing Address - Country:US
Mailing Address - Phone:517-887-9875
Mailing Address - Fax:517-579-0287
Practice Address - Street 1:6 LOCUST LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-1152
Practice Address - Country:US
Practice Address - Phone:517-887-9875
Practice Address - Fax:517-579-0287
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010350921041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool