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General NPI Number Information
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NPI Number | 1134817257
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE OWEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 3662 CEDARCREST RD
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City | ACWORTH
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State | GA
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Zip | 30101-8928
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Country | US
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Telephone | 770-842-4907
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Fax |
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Provider Business Mailing Address
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Address Line | 59 SENTRY RDG
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City | DALLAS
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State | GA
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Zip | 30157-7928
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Country | US
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Telephone | 770-842-4907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006794
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License Number State | GA
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