Provider Demographics
NPI:1538237714
Name:FOWLER, LORI A (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SANDCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3047
Mailing Address - Country:US
Mailing Address - Phone:812-372-3177
Mailing Address - Fax:
Practice Address - Street 1:2530 SANDCREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3047
Practice Address - Country:US
Practice Address - Phone:812-372-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003431A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN144010JMedicare ID - Type UnspecifiedMEDICARE PROVIDER #