Provider Demographics
NPI:1477676054
Name:PICKERING-FOWLER, KERRI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:
Last Name:PICKERING-FOWLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 VILLAGE SQUARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3707
Mailing Address - Country:US
Mailing Address - Phone:719-338-8825
Mailing Address - Fax:
Practice Address - Street 1:7501 VILLAGE SQUARE DR STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-3707
Practice Address - Country:US
Practice Address - Phone:719-338-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical