Provider Demographics
NPI:1659797652
Name:OWENS, DEWANDA
Entity Type:Individual
Prefix:
First Name:DEWANDA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BOND STREET
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:LA
Mailing Address - Zip Code:71336
Mailing Address - Country:US
Mailing Address - Phone:972-589-2549
Mailing Address - Fax:
Practice Address - Street 1:419 LAPALCO BLVD STE 6
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7371
Practice Address - Country:US
Practice Address - Phone:972-589-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 251C00000X, 251T00000X, 253Z00000X, 261QA0600X, 261QM0801X, 261QR0800X, 372600000X, 385H00000X, 385HR2050X, 385HR2060X, 385HR2065X, 390200000X
LA261QM0801X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program