MEDICARE: MRS. SARAH ROSE FOWLER LPC, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11456	CO

General Provider Information

NPI Number	:	1386083806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH ROSE FOWLER LPC, MS

Provider Business Mailing Address
First Line	:	44 E SPAULDING AVE STE 1
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-542-0032
Fax Number	:	719-296-6218

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE STE 1
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-542-0032
Fax Number	:	719-296-6218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	09/20/2021

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