Provider Demographics
NPI:1962130484
Name:FOWLER, LORA CAITLYNN (AUD)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:CAITLYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST STE T-240
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4624
Mailing Address - Country:US
Mailing Address - Phone:907-279-8800
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER ST STE T-240
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-279-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK198406OtherSTATE AUDIOLOGY LICENSE