Basic Information
| Provider Information | |||||||||
| NPI: | 1528144102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302754216 | ||||||||
| FaxNumber: | 5128582714 | ||||||||
| Practice Location | |||||||||
| Address1: | 5977 E GRANT RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208335378 | ||||||||
| FaxNumber: | 5204334918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | HAD1579 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | DA1425 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | DA1425 | AZ | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | DA1425 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.