Healthcare Provider Details

I. General information

NPI: 1073475281
Provider Name (Legal Business Name): HANNAH RACHEL FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25900 DEQUINDRE RD STE C
WARREN MI
48091-6107
US

IV. Provider business mailing address

25900 DEQUINDRE RD STE C
WARREN MI
48091-6107
US

V. Phone/Fax

Practice location:
  • Phone: 586-212-4779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: