Individual
JESSICA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IMFT-S, LPCC-S
Contact information
Practice address
807 E WASHINGTON ST, MEDINA, OH 44256-3338
(330) 241-4444
Mailing address
807 E WASHINGTON ST, MEDINA, OH 44256-3338
(330) 241-4444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E.1800520-SUPV
OH
106H00000X
Marriage & Family Therapist
F.1800035-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0260282
—
OH
Enumeration date
12/07/2016
Last updated
01/23/2020
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