Provider Demographics
NPI:1184673915
Name:OWENS, DONALD MCCLAREN JR (CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MCCLAREN
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10908 CHESTNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7602
Mailing Address - Country:US
Mailing Address - Phone:704-846-2198
Mailing Address - Fax:
Practice Address - Street 1:10908 CHESTNUT HILL DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7602
Practice Address - Country:US
Practice Address - Phone:704-846-2198
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSAN030Medicaid