Healthcare Provider Details

I. General information

NPI: 1245193127
Provider Name (Legal Business Name): JENNIFER OWINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 MCINTOSH CT
SPRINGFIELD IL
62711-6815
US

IV. Provider business mailing address

409 HODGES CT
CHATHAM IL
62629-2207
US

V. Phone/Fax

Practice location:
  • Phone: 618-967-8859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: