Provider Demographics
NPI:1841756582
Name:KYMRY FOWLER
Entity Type:Organization
Organization Name:KYMRY FOWLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIN ICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYMRY
Authorized Official - Middle Name:HART
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:949-374-4868
Mailing Address - Street 1:140 SOUTH FLOWER STREET, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3467
Mailing Address - Country:US
Mailing Address - Phone:714-683-5876
Mailing Address - Fax:888-420-6257
Practice Address - Street 1:140 SOUTH FLOWER STREET, SUITE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3467
Practice Address - Country:US
Practice Address - Phone:714-683-5876
Practice Address - Fax:888-420-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty