MEDICARE: DR. KENNETH W. SEWELL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	24917	TX

General Provider Information

NPI Number	:	1104913847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W. SEWELL PH.D.

Provider Business Mailing Address
First Line	:	9818 MAPLE DR
Second Line	:
City	:	PROVIDENCE VILLAGE
State	:	TX
Zip	:	76227-5442
Country	:	US
Telephone Number	:	940-453-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 LONDONDERRY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7878
Country	:	US
Telephone Number	:	940-453-4515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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