Healthcare Provider Details

I. General information

NPI: 1386708386
Provider Name (Legal Business Name): DAWN J FOWLER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 5TH ST
METROPOLIS IL
62960-1810
US

IV. Provider business mailing address

206 W 5TH ST
METROPOLIS IL
62960-1810
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-9680
  • Fax:
Mailing address:
  • Phone: 618-524-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: