Provider Demographics
NPI:1598718827
Name:OWENS, KENNETH W (AUD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:OWENS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3934
Mailing Address - Country:US
Mailing Address - Phone:918-687-4517
Mailing Address - Fax:918-687-4517
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-683-3261
Practice Address - Fax:918-680-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK221231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist