Provider Demographics
NPI:1447462494
Name:SHOWALTER, KENNETH EARLE (PSY D)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EARLE
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 OHIO ST
Mailing Address - Street 2:SUITE M-1
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-2467
Mailing Address - Country:US
Mailing Address - Phone:540-448-2538
Mailing Address - Fax:
Practice Address - Street 1:1320 OHIO ST
Practice Address - Street 2:SUITE M-1
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-2467
Practice Address - Country:US
Practice Address - Phone:540-448-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001960103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic