Provider Demographics
NPI:1366283566
Name:FOWLER, JADE ELIZABETH
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:ELIZABETH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ELIZABETH
Other - Last Name:MEICHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12581 DUNCAN LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8796
Mailing Address - Country:US
Mailing Address - Phone:608-772-9895
Mailing Address - Fax:
Practice Address - Street 1:101 W EVERGREEN PKWY STE 1
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4083
Practice Address - Country:US
Practice Address - Phone:262-475-5684
Practice Address - Fax:414-325-7753
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor