Healthcare Provider Details

I. General information

NPI: 1891607503
Provider Name (Legal Business Name): LOGAN SOWDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10A N FULTON AVE
EVANSVILLE IN
47710-1034
US

IV. Provider business mailing address

10A N FULTON AVE
EVANSVILLE IN
47710-1034
US

V. Phone/Fax

Practice location:
  • Phone: 812-202-6001
  • Fax:
Mailing address:
  • Phone: 812-202-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2852275
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: