Provider Demographics
NPI:1306228275
Name:FOWLER, LAURA (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 POCONO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5615
Mailing Address - Country:US
Mailing Address - Phone:614-800-7526
Mailing Address - Fax:
Practice Address - Street 1:319 POCONO RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5615
Practice Address - Country:US
Practice Address - Phone:614-800-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist