Provider Demographics
NPI:1710193925
Name:OWENS, JAIME WENDEL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:WENDEL
Last Name:OWENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:LAKE COMO
Mailing Address - State:FL
Mailing Address - Zip Code:32157-0118
Mailing Address - Country:US
Mailing Address - Phone:386-972-0091
Mailing Address - Fax:386-649-2501
Practice Address - Street 1:7731 W NEWBERRY RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6725
Practice Address - Country:US
Practice Address - Phone:352-332-8600
Practice Address - Fax:352-332-8911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 30601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical