Individual
KIRK P FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDP
Contact information
Practice address
100 N TRIBAL CENTER RD, SKOKOMISH NATION, WA 98584-9748
(360) 877-2008
Mailing address
100 N TRIBAL CENTER RD, SKOKOMISH NATION, WA 98584-9748
(360) 877-2008
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60625039
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2077844
—
WA
Enumeration date
12/28/2018
Last updated
01/31/2025
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