Provider Demographics
NPI:1114588910
Name:OWENS, ROBERT CHANNING (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHANNING
Last Name:OWENS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:CHANNING
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ROBERT C OWENS MS
Mailing Address - Street 1:7547 S WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5206
Mailing Address - Country:US
Mailing Address - Phone:708-646-6997
Mailing Address - Fax:
Practice Address - Street 1:7547 S WOLCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5206
Practice Address - Country:US
Practice Address - Phone:708-646-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health