Individual
MR. KENNITH WAYNE FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP 60311706
Contact information
Practice address
901 RAINIER AVE S, SEATTLE, WA 98144-2839
(206) 470-3856
Mailing address
7700 RAINIER AVE S APT 405, SEATTLE, WA 98118-4163
(206) 229-9048
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60311706
WA
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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