Provider Demographics
NPI:1295905354
Name:FOWLES, JUDITH BUTLER
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:BUTLER
Last Name:FOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BIGELOW HILL RD
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-5226
Mailing Address - Country:US
Mailing Address - Phone:207-474-2014
Mailing Address - Fax:207-474-2014
Practice Address - Street 1:519 BIGELOW HILL RD
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-5226
Practice Address - Country:US
Practice Address - Phone:207-474-2014
Practice Address - Fax:207-474-2014
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional