MEDICARE: SARA RUTH OWENS PH.D.

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	103TC0700X	Clinical Psychologist	0800	NM

General Provider Information

NPI Number	:	1396864419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA RUTH OWENS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 22846
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-2846
Country	:	US
Telephone Number	:	505-660-8240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 OLD PECOS TRL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4779
Country	:	US
Telephone Number	:	505-660-8240
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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