Individual
MS. JACQUELINE BERNICE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HAPP, LMT
Contact information
Practice address
8620 MAPLE AVE, GARY, IN 46403-1423
(219) 963-2956
Mailing address
8620 MAPLE AVE, GARY, IN 46403-1423
(219) 963-2956
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
171100000X
Acupuncturist
00000
IN
172M00000X
Mechanotherapist
Primary
—
IN
173C00000X
Reflexologist
—
—
175F00000X
Naturopath
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
HOLISTIC ALTERNATIVE PSYCHOLOGY PRACTITIONER
IN
01
—
MT209011898
LICENSED MASSAGE THERAPIST/ MECHANO THERAPIST
IN
Enumeration date
03/13/2008
Last updated
03/03/2022
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