Provider Demographics
NPI:1912583006
Name:FOWLER, DAWN (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCAC
Mailing Address - Street 1:2667 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1205
Mailing Address - Country:US
Mailing Address - Phone:954-892-8399
Mailing Address - Fax:
Practice Address - Street 1:2667 CHATHAM DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1205
Practice Address - Country:US
Practice Address - Phone:954-892-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005338A1041C0700X
FLSW106591041C0700X
MO20130402601041C0700X
IN87000684A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical