Provider Demographics
NPI:1093371569
Name:SOWELL, KEITH WILLIAM
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WILLIAM
Last Name:SOWELL
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 1:6012 EAGLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5778
Mailing Address - Country:US
Mailing Address - Phone:501-231-8354
Mailing Address - Fax:
Practice Address - Street 1:6012 EAGLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-5778
Practice Address - Country:US
Practice Address - Phone:501-231-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist