Organization
FOWLER PSYCHOLOGICAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RICHARD FOWLER PHD (PRESIDENT)
(952) 545-8833
Entity
Organization
Contact information
Practice address
5353 GAMBLE DR, SUITE 108, ST LOUIS PARK, MN 55416
(952) 545-8833
Mailing address
5353 GAMBLE DR, SUITE 108, ST LOUIS PARK, MN 55416
(952) 545-8833
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14757F0
BCBS
MN
01
—
1581524
MEDICA
MN
Enumeration date
08/30/2006
Last updated
08/22/2020
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