Provider Demographics
NPI:1255001434
Name:OWEN, ELLEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:OWEN
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1148
Mailing Address - Country:US
Mailing Address - Phone:970-799-8946
Mailing Address - Fax:
Practice Address - Street 1:1753 WYATT PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4041
Practice Address - Country:US
Practice Address - Phone:970-799-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1262661041C0700X
IA1178871041C0700X
MD285171041C0700X
NJ44SC062381001041C0700X
NCC0166811041C0700X
VT89.01345491041C0700X
PACW0220461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical