Provider Demographics
NPI:1467733634
Name:SEWELL, MEGAN ELAINE (LAC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 E FORT UNION BLVD
Mailing Address - Street 2:#36
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-849-8312
Mailing Address - Fax:206-374-8202
Practice Address - Street 1:2258 E FORT UNION BLVD
Practice Address - Street 2:#36
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-849-8312
Practice Address - Fax:206-374-8202
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60204424171100000X
UT10964315-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist