MEDICARE: SADE SOWELL

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1174252639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADE SOWELL

Provider Business Mailing Address
First Line	:	2623 N 24TH PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1047
Country	:	US
Telephone Number	:	920-441-3018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 N 24TH PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1047
Country	:	US
Telephone Number	:	920-441-3018
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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Directions to “ SADE SOWELL ” Practice Location

Language	Start Address	Practice Location

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