Individual
SHANNON FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
741 RIVERBEND BLVD, LONGWOOD, FL 32779-2347
(734) 474-0530
Mailing address
741 RIVERBEND BLVD, LONGWOOD, FL 32779-2347
(734) 474-0530
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0810005172
VA
103TC0700X
Clinical Psychologist
Primary
6301016051
MI
103TC0700X
Clinical Psychologist
PY10662
FL
Other
Enumeration date
09/09/2014
Last updated
12/09/2021
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