Provider Demographics
NPI:1457863409
Name:LOWIS, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:LOWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17780 1 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MORLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49336-9743
Mailing Address - Country:US
Mailing Address - Phone:231-250-2713
Mailing Address - Fax:
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-250-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician