Provider Demographics
NPI:1831224625
Name:SOWDER, RENEA ANNETTE (MED, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:RENEA
Middle Name:ANNETTE
Last Name:SOWDER
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2439
Mailing Address - Country:US
Mailing Address - Phone:208-596-0406
Mailing Address - Fax:208-882-4908
Practice Address - Street 1:PSYCHOLOGY COMMUNICATIVE STUDIES
Practice Address - Street 2:UNIVERSITY OF IDAHO
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-3043
Practice Address - Country:US
Practice Address - Phone:208-885-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDX6884OtherBLUE CROSS ID PROVIDER #
ID000010157093OtherREGENCE IDAHO PROVIDER #