Provider Demographics
NPI:1033720511
Name:OWEN, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:
Other - Last Name:WARDROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2450 SE 37TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5886
Mailing Address - Country:US
Mailing Address - Phone:503-549-4714
Mailing Address - Fax:
Practice Address - Street 1:529 SE DIVISION ST
Practice Address - Street 2:STE 520
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-9721
Practice Address - Country:US
Practice Address - Phone:503-506-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor