Healthcare Provider Details

I. General information

NPI: 1538564521
Provider Name (Legal Business Name): MICHELLE L OWENS LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 COMMERCE PARK W DR
GREENSBURG IN
47240-3205
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-663-7057
  • Fax: 812-663-6735
Mailing address:
  • Phone: 812-337-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007732A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: