Provider Demographics
NPI:1558672766
Name:SEWELL, HODALEE
Entity Type:Individual
Prefix:MR
First Name:HODALEE
Middle Name:
Last Name:SEWELL
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 1:401 S MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8021
Mailing Address - Country:US
Mailing Address - Phone:850-254-5426
Mailing Address - Fax:
Practice Address - Street 1:120 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3202
Practice Address - Country:US
Practice Address - Phone:918-256-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator