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General NPI Number Information
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NPI Number | 1407372907
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Entity Type | Individual
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Provider Name | JANNA MARIE OWENS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 2411 PATHWAYS XING
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City | BELLEVILLE
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State | IL
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Zip | 62221-5885
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Country | US
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Telephone | 618-355-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 PATHWAYS XING
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City | BELLEVILLE
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State | IL
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Zip | 62221-5885
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Country | US
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Telephone | 618-355-4421
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2016024372
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 143.013617
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License Number State | IL
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