Individual ProviderCarly FowlerSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address13336 Industrial Rd, Suite 105, Omaha, NE 68137-1124(402) 330-3211PECOS EnrollmentBased on the most recent information from CMS, provider Carly Fowler does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:05 AM.Profile DetailsProvider ID1497132443Provider TypeIndividualFull NameFowler, CarlyCredentialMS-CCC-SLPGenderFemaleSole ProprietorNoEnumeration Date4/29/2015Last Updated4/29/2015Contact InformationPractice LocationPractice Address13336 Industrial Rd, Suite 105, Omaha, NE 68137-1124Phone(402) 330-3211Fax(402) 330-5970Mailing LocationMailing Address13336 Industrial Rd, Suite 105, Omaha, NE 68137-1124Phone(402) 330-3211Fax(402) 330-5970Provider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense1741NebraskaProvider IdentifiersIDDescriptionIssuerID47065477700DescriptionMedicaidIssuerUnlistedNebraska