Provider Demographics
NPI:1770270902
Name:OWENS, AMY BETHANY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETHANY
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 JOYCE PL
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-0150
Mailing Address - Country:US
Mailing Address - Phone:435-209-0028
Mailing Address - Fax:
Practice Address - Street 1:54 JOYCE PL
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-0150
Practice Address - Country:US
Practice Address - Phone:435-209-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services