Healthcare Provider Details

I. General information

NPI: 1871990002
Provider Name (Legal Business Name): ASHLEE FOWLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 02/13/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 LAUREATE DRIVE
HOLT MI
48842
US

IV. Provider business mailing address

3003 E MICHIGAN AVE STE 1139
LANSING MI
48912-4616
US

V. Phone/Fax

Practice location:
  • Phone: 231-590-6305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: