Provider Demographics
NPI:1295104917
Name:FOWLER, CHRISTINE KAY (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:KAY
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 V ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3348
Mailing Address - Country:US
Mailing Address - Phone:402-681-8817
Mailing Address - Fax:
Practice Address - Street 1:12505 V ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3348
Practice Address - Country:US
Practice Address - Phone:402-681-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist