Healthcare Provider Details

I. General information

NPI: 1548942287
Provider Name (Legal Business Name): KRISTINA ANNE FOWLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAIA FOWLER LPC

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E CLAIREMONT AVE STE 2
EAU CLAIRE WI
54701-4761
US

IV. Provider business mailing address

N10863 COUNTY ROAD G
NECEDAH WI
54646-7959
US

V. Phone/Fax

Practice location:
  • Phone: 763-210-9966
  • Fax: 763-210-6886
Mailing address:
  • Phone: 920-728-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7353-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11431-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11431-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: