Provider Demographics
NPI:1508315508
Name:OWENS SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:OWENS SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MURRY
Authorized Official - Middle Name:STEEN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-258-3466
Mailing Address - Street 1:3163 N RAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6513
Mailing Address - Country:US
Mailing Address - Phone:501-258-3466
Mailing Address - Fax:
Practice Address - Street 1:5305 W VILLAGE PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8102
Practice Address - Country:US
Practice Address - Phone:501-258-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-02
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217022742Medicaid