Healthcare Provider Details

I. General information

NPI: 1760049530
Provider Name (Legal Business Name): JENIA FOWLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 5TH AVE NW
ATTALLA AL
35954-2214
US

IV. Provider business mailing address

425 5TH AVE NW
ATTALLA AL
35954-2214
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-7800
  • Fax: 256-494-5536
Mailing address:
  • Phone: 256-492-7800
  • Fax: 256-494-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4049C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: