Provider Demographics
NPI:1336114859
Name:SOWARDS, STEPHEN KELLEY (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KELLEY
Last Name:SOWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S MORNINGSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1815
Mailing Address - Country:US
Mailing Address - Phone:316-260-4848
Mailing Address - Fax:
Practice Address - Street 1:329 S MORNINGSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1815
Practice Address - Country:US
Practice Address - Phone:316-260-4848
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS004467Medicare ID - Type Unspecified