MEDICARE: MS. SHIRLEY MARIE OWENS MS CCC/SLP

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	235Z00000X	Speech-Language Pathologist	8982	CA

General Provider Information

NPI Number	:	1619372331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY MARIE OWENS MS CCC/SLP

Provider Business Mailing Address
First Line	:	249 E OCEAN BLVD
Second Line	:	SUITE 400
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4849
Country	:	US
Telephone Number	:	888-808-7838
Fax Number	:	866-620-3943

Provider Business Practice Location Address
First Line	:	249 E OCEAN BLVD
Second Line	:	SUITE 400
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4849
Country	:	US
Telephone Number	:	888-808-7838
Fax Number	:	866-620-3943

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

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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