Provider Demographics
NPI:1548942287
Name:FOWLER, KRISTINA ANNE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANNE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAIA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:N10863 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:NECEDAH
Mailing Address - State:WI
Mailing Address - Zip Code:54646-7959
Mailing Address - Country:US
Mailing Address - Phone:920-728-3004
Mailing Address - Fax:
Practice Address - Street 1:2115 E CLAIREMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4761
Practice Address - Country:US
Practice Address - Phone:763-210-9966
Practice Address - Fax:763-210-6886
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7353-226101Y00000X
WI11431-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health