Provider Demographics
NPI:1033720511
Name:WARDROP, OWEN FAYE
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:FAYE
Last Name:WARDROP
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1327 SE TACOMA ST STE 307
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6639
Mailing Address - Country:US
Mailing Address - Phone:504-545-8465
Mailing Address - Fax:
Practice Address - Street 1:529 SE DIVISION ST
Practice Address - Street 2:STE 520
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-9721
Practice Address - Country:US
Practice Address - Phone:503-506-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORL16261104100000X
OR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor