Provider Demographics
NPI:1871375196
Name:FOWLER-CURRAN, JODIE ANN (MC 61263712)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ANN
Last Name:FOWLER-CURRAN
Suffix:
Gender:F
Credentials:MC 61263712
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:A
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4502 RUDDELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4334
Mailing Address - Country:US
Mailing Address - Phone:206-330-6227
Mailing Address - Fax:
Practice Address - Street 1:1801 W BAY DR NW STE 702
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4310
Practice Address - Country:US
Practice Address - Phone:206-330-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61263713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist