Healthcare Provider Details

I. General information

NPI: 1851998413
Provider Name (Legal Business Name): ELIJAH SOWRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVERSMAN DR
JASPER IN
47546-3548
US

IV. Provider business mailing address

711 CLAY ST
JASPER IN
47546-3005
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-3020
  • Fax:
Mailing address:
  • Phone: 937-269-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012647A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: