Provider Demographics
NPI:1376596577
Name:OWEN, JACQUELYN M (MA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:2800 RIVERSIDE PKWY
Practice Address - Street 2:BLDG 2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4721
Practice Address - Country:US
Practice Address - Phone:970-245-4213
Practice Address - Fax:970-243-7297
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6157101YA0400X
CO1854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)