Provider Demographics
NPI:1922273598
Name:OWEN, EDWARD (TED) DORRANCE (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD (TED)
Middle Name:DORRANCE
Last Name:OWEN
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 NW LEAHY RD
Mailing Address - Street 2:APT 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6382
Mailing Address - Country:US
Mailing Address - Phone:503-957-7570
Mailing Address - Fax:
Practice Address - Street 1:9601 NW LEAHY RD
Practice Address - Street 2:APT 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6382
Practice Address - Country:US
Practice Address - Phone:503-957-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator