MEDICARE: ERIKA DAWN OWEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149020381	IL

General Provider Information

NPI Number	:	1346860376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DAWN OWEN LCSW

Provider Business Mailing Address
First Line	:	441 E ERIE ST APT 2113
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-7121
Country	:	US
Telephone Number	:	661-678-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 E ERIE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4446
Country	:	US
Telephone Number	:	661-678-3250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	04/20/2020

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