Provider Demographics
NPI:1255104550
Name:FOWLER, SHIANA MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:SHIANA
Middle Name:MICHELLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4044
Mailing Address - Country:US
Mailing Address - Phone:208-966-4206
Mailing Address - Fax:
Practice Address - Street 1:1400 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4044
Practice Address - Country:US
Practice Address - Phone:208-966-4206
Practice Address - Fax:208-966-4220
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-44306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker