Provider Demographics
NPI:1912633678
Name:FOWLER, KASIE MADISON (MS CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:KASIE
Middle Name:MADISON
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-2218
Mailing Address - Country:US
Mailing Address - Phone:434-607-5499
Mailing Address - Fax:
Practice Address - Street 1:9900 KRAUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6535
Practice Address - Country:US
Practice Address - Phone:804-748-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist