Provider Demographics
NPI:1114942455
Name:OWEN, LAURIE M (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:M
Last Name:OWEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 ENCINITAS BLVD STE O
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4376
Mailing Address - Country:US
Mailing Address - Phone:760-634-1553
Mailing Address - Fax:760-634-1660
Practice Address - Street 1:2210 ENCINITAS BLVD STE O
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4376
Practice Address - Country:US
Practice Address - Phone:760-634-1553
Practice Address - Fax:760-634-1660
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU998237600000X
CAHA 2138237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter