Provider Demographics
NPI:1225643901
Name:OWEN, KEVIN ALAN (SUDC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:OWEN
Suffix:
Gender:M
Credentials:SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N 100 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1803
Mailing Address - Country:US
Mailing Address - Phone:385-225-0463
Mailing Address - Fax:
Practice Address - Street 1:1291 EXPRESSWAY LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1333
Practice Address - Country:US
Practice Address - Phone:801-367-0394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)