Provider Demographics
NPI:1487294203
Name:FOWLDS, LEANNA APRIL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:APRIL
Last Name:FOWLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MISSOURI BLVD.
Mailing Address - Street 2:STE. 102 #139
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1134
Mailing Address - Country:US
Mailing Address - Phone:573-469-2433
Mailing Address - Fax:573-550-2436
Practice Address - Street 1:57109 QUENTIN DR
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-6000
Practice Address - Country:US
Practice Address - Phone:573-469-2433
Practice Address - Fax:573-550-2436
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210314141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical