Provider Demographics
NPI:1003388349
Name:POWNALL, STEPHEN CODY
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CODY
Last Name:POWNALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1244
Mailing Address - Country:US
Mailing Address - Phone:304-830-4775
Mailing Address - Fax:
Practice Address - Street 1:1010 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1846
Practice Address - Country:US
Practice Address - Phone:740-283-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator