Healthcare Provider Details

I. General information

NPI: 1063968873
Provider Name (Legal Business Name): EBONY S. OWENS PLBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 EVELINE ST
SAINT LOUIS MO
63139-3012
US

IV. Provider business mailing address

6104 EVELINE ST
SAINT LOUIS MO
63139-3012
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-1105
  • Fax:
Mailing address:
  • Phone: 314-932-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026007303
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: