Provider Demographics
NPI:1114590387
Name:FOWLER, SHAWN D
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:D
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12557 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12557 RAVENWOOD DR.
Practice Address - Street 2:RAVENWOOD MENTAL HEALTH CENTER
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-4402
Practice Address - Country:US
Practice Address - Phone:356-844-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator