Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6587 | KY |
NPI | 1952851255 |
---|---|
Provider Name | Jennifer Owen |
First Address | Calhoun, KY 42327-0654 |
Second Address | Calhoun, KY 42327-0654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 11/10/2016 |