Healthcare Provider Details

I. General information

NPI: 1013288471
Provider Name (Legal Business Name): JODILYN OWEN LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S WILLOW ST
SEATTLE WA
98118-3463
US

IV. Provider business mailing address

5370 WILSON AVE S
SEATTLE WA
98118-2566
US

V. Phone/Fax

Practice location:
  • Phone: 206-261-2312
  • Fax:
Mailing address:
  • Phone: 206-261-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60268888
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: