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NPI Code Detail

MEDICARE: DR. JESSE J OWEN PHD

MEDICARE: DR. JESSE J OWEN PHD
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
1103T00000XPsychologistPS016186PA

General Provider Information

NPI Number : 1124158605
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE J OWEN PHD
Provider Business Mailing Address
First Line : 1047 W 28TH ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1527
Country : US
Telephone Number : 814-871-7733
Fax Number :
Provider Business Practice Location Address
First Line : 109 UNIVERSITY SQ
Second Line :
City : ERIE
State : PA
Zip : 16541-0002
Country : US
Telephone Number : 814-871-7733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/08/2007

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