Provider Demographics
NPI:1952851255
Name:OWEN, JENNIFER (CSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:CSW
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 654
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-0654
Mailing Address - Country:US
Mailing Address - Phone:270-273-3050
Mailing Address - Fax:270-273-3052
Practice Address - Street 1:180 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327-0654
Practice Address - Country:US
Practice Address - Phone:270-273-3050
Practice Address - Fax:270-273-3052
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical