Individual
MISS KELLIE DIANA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CBT
Contact information
Practice address
3214 W MCGRAW ST STE 212, SEATTLE, WA 98199-3239
(206) 453-4882
Mailing address
5437 FAUNTLEROY WAY SW APT N, SEATTLE, WA 98136-1557
(914) 419-7140
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
60780423
WA
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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