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General NPI Number Information
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NPI Number | 1447611066
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Entity Type | Individual
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Provider Name | MARC FOWLER
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Gender | Male
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 3330 MONTE VILLA PKWY
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City | BOTHELL
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State | WA
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Zip | 98021-8972
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Country | US
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Telephone | 425-408-7733
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Fax | 425-408-7740
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Provider Business Mailing Address
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Address Line | 311 13TH AVE E APT 6
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City | SEATTLE
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State | WA
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Zip | 98102-6103
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Country | US
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Telephone | 646-853-3970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 60680511
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License Number State | WA
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