MEDICARE: MRS. JANE S OWEN 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	CW019399	PA

General Provider Information

NPI Number	:	1114447851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE S OWEN LCSW

Provider Business Mailing Address
First Line	:	445 TIMBER LAKE RD
Second Line	:
City	:	CLAYSVILLE
State	:	PA
Zip	:	15323-1325
Country	:	US
Telephone Number	:	724-206-9558
Fax Number	:	724-993-4052

Provider Business Practice Location Address
First Line	:	955 W CHESTNUT ST APT 5
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-4669
Country	:	US
Telephone Number	:	724-206-9558
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	06/23/2017

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