Provider Demographics
NPI:1922504216
Name:OWEN, LINDSAY RAE (CRM)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:RAE
Last Name:OWEN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N EVEREST ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2116
Mailing Address - Country:US
Mailing Address - Phone:503-538-7647
Mailing Address - Fax:503-538-9015
Practice Address - Street 1:120 N EVEREST ST STE A
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2116
Practice Address - Country:US
Practice Address - Phone:503-538-7647
Practice Address - Fax:503-538-9015
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-CRM-171172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty