Provider Demographics
NPI:1336799915
Name:FOWLER, BENJAMIN ALAN WEST
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALAN WEST
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18503 SE 267TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4746 11TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4660
Practice Address - Country:US
Practice Address - Phone:206-535-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-25
Deactivation Date:2019-09-17
Deactivation Code:
Reactivation Date:2019-09-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst