Provider Demographics
NPI:1629117932
Name:STOWELL, SANDRA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:STOWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6591
Mailing Address - Country:US
Mailing Address - Phone:916-764-0491
Mailing Address - Fax:530-753-0220
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6591
Practice Address - Country:US
Practice Address - Phone:916-764-0491
Practice Address - Fax:530-753-0220
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW27919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker