Provider Demographics
NPI:1467142299
Name:FOWLER, SUSAN IONA
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:IONA
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:IONA
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2036 W PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4502
Mailing Address - Country:US
Mailing Address - Phone:707-297-1267
Mailing Address - Fax:
Practice Address - Street 1:2036 W PUEBLO AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4502
Practice Address - Country:US
Practice Address - Phone:707-297-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor