Individual
MS. CINDY FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
454 N 7TH AVE, POCATELLO, ID 83201-5706
(208) 240-8419
Mailing address
454 N 7TH AVE, POCATELLO, ID 83201-5706
(208) 240-8419
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
00000
ID
106S00000X
Behavior Technician
—
ID
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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