Provider Demographics
NPI:1407356637
Name:OWENS, MARK N (BS, CSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:OWENS
Suffix:
Gender:M
Credentials:BS, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3152 HWY 81
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-9397
Mailing Address - Country:US
Mailing Address - Phone:608-381-3066
Mailing Address - Fax:
Practice Address - Street 1:N3152 HWY 81
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-9397
Practice Address - Country:US
Practice Address - Phone:608-381-3066
Practice Address - Fax:608-381-3066
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker