Provider Demographics
NPI:1164470712
Name:OWEN, ROBERT ALAN (LMP, DIP C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:OWEN
Suffix:
Gender:M
Credentials:LMP, DIP C
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1953 25TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3009
Mailing Address - Country:US
Mailing Address - Phone:206-324-3495
Mailing Address - Fax:
Practice Address - Street 1:1953 25TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3009
Practice Address - Country:US
Practice Address - Phone:206-324-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004059101YM0800X
WAMA00001829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOW 3077OtherREGENCE BLUE SHIELD