Provider Demographics
NPI:1407098510
Name:SOWELL, STEVEN RICKY (CCP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICKY
Last Name:SOWELL
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 E LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3229
Mailing Address - Country:US
Mailing Address - Phone:602-406-5194
Mailing Address - Fax:602-798-9540
Practice Address - Street 1:1929 E LIBRA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3229
Practice Address - Country:US
Practice Address - Phone:602-406-5194
Practice Address - Fax:602-798-9540
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist