Provider Demographics
NPI:1518853480
Name:FOWLER, JERI K (PLPC)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:K
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9505
Mailing Address - Country:US
Mailing Address - Phone:406-696-8747
Mailing Address - Fax:
Practice Address - Street 1:310 S 26TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3355
Practice Address - Country:US
Practice Address - Phone:406-696-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD21111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional