Provider Demographics
NPI:1942338967
Name:FOWLER, KIMBERLY MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:4 GERMAY CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5519
Mailing Address - Country:US
Mailing Address - Phone:501-821-4750
Mailing Address - Fax:501-821-8861
Practice Address - Street 1:11324 ARCADE DR
Practice Address - Street 2:SUITE 10
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4074
Practice Address - Country:US
Practice Address - Phone:501-993-8707
Practice Address - Fax:501-223-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARSP#1463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist