Provider Demographics
NPI:1619372331
Name:OWENS, SHIRLEY MARIE (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:OWENS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E OCEAN BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4849
Mailing Address - Country:US
Mailing Address - Phone:888-808-7838
Mailing Address - Fax:866-620-3943
Practice Address - Street 1:249 E OCEAN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4849
Practice Address - Country:US
Practice Address - Phone:888-808-7838
Practice Address - Fax:866-620-3943
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist