Individual
ANASTASIA TATIANA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 WILMINGTON DR STE 220, DUPONT, WA 98327-8773
(206) 453-4882
Mailing address
6927 BIRDSEYE AVE NE APT 315, LACEY, WA 98516-4556
(315) 864-0006
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/12/2019
Last updated
12/12/2019
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