Individual
DR. BRUCE ALLEN FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2090 CELEBRATION DR NE, SUITE 212, GRAND RAPIDS, MI 49525-9200
(616) 450-4601
(616) 608-0108
Mailing address
2090 CELEBRATION DR NE, SUITE 212, GRAND RAPIDS, MI 49525-9200
(616) 450-4601
(616) 608-0108
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301006137
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680D115690
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
09/20/2006
Last updated
02/08/2017
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