Provider Demographics
NPI:1770581043
Name:SOWALD, DEBRA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:K
Last Name:SOWALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E RAHN RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5461
Mailing Address - Country:US
Mailing Address - Phone:937-434-6840
Mailing Address - Fax:937-436-9408
Practice Address - Street 1:28 E RAHN RD
Practice Address - Street 2:STE 105
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5461
Practice Address - Country:US
Practice Address - Phone:937-434-6840
Practice Address - Fax:937-436-9408
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001388101Y00000X
OH3417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0541775Medicaid
OH0541775Medicaid