Provider Demographics
NPI:1962711168
Name:FOWLER, SUZIE (MAT, CCC)
Entity type:Individual
Prefix:MS
First Name:SUZIE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MAT, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2862
Mailing Address - Country:US
Mailing Address - Phone:504-891-5509
Mailing Address - Fax:504-895-1225
Practice Address - Street 1:923 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2862
Practice Address - Country:US
Practice Address - Phone:504-891-5509
Practice Address - Fax:504-895-1225
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist