Provider Demographics
NPI:1639317100
Name:FOWLER, JERRI ANNETTE (SLP)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:ANNETTE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 WADE RD
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:KY
Mailing Address - Zip Code:42217-8239
Mailing Address - Country:US
Mailing Address - Phone:270-839-3886
Mailing Address - Fax:
Practice Address - Street 1:1187 WADE RD
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:KY
Practice Address - Zip Code:42217-8239
Practice Address - Country:US
Practice Address - Phone:270-269-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist