Provider Demographics
NPI:1679790042
Name:SMELKO, BOWMAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BOWMAN
Middle Name:
Last Name:SMELKO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 WAGNER PLACE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601
Mailing Address - Country:US
Mailing Address - Phone:406-282-1744
Mailing Address - Fax:
Practice Address - Street 1:1225 BIRCH ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0617
Practice Address - Country:US
Practice Address - Phone:406-443-2977
Practice Address - Fax:406-443-2960
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY2788103T00000X
MT394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist