Provider Demographics
NPI:1578125662
Name:FOWLER, BRITTNI
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRITTNI
Other - Middle Name:
Other - Last Name:FUNDERBURK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:15 CARNEGIE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2579
Mailing Address - Country:US
Mailing Address - Phone:406-799-1366
Mailing Address - Fax:
Practice Address - Street 1:38 E WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3975
Practice Address - Country:US
Practice Address - Phone:406-799-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical