MEDICARE: VANESSA L OWEN MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L3621	OR

General Provider Information

NPI Number	:	1023160868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA L OWEN MSW, LCSW

Provider Business Mailing Address
First Line	:	201 B AVENUE
Second Line	:	SUITE 255
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034
Country	:	US
Telephone Number	:	503-516-6085
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 B AVE
Second Line	:	SUITE 255
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3159
Country	:	US
Telephone Number	:	503-516-6085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/27/2012

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