MEDICARE: JENNIFER LAURA OWENS

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	101YP2500X	Professional Counselor	12201	CA

General Provider Information

NPI Number	:	1346470671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAURA OWENS

Provider Business Mailing Address
First Line	:	PO BOX 1987
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-1987
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 FOWLER LN STE 204
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9782
Country	:	US
Telephone Number	:	530-626-3105
Fax Number	:

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	02/01/2024

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