MEDICARE: KRISTEN 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1508017518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN OWENS

Provider Business Mailing Address
First Line	:	10 MEADOWBROOK RD
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7122
Country	:	US
Telephone Number	:	817-683-2369
Fax Number	:	508-408-6192

Provider Business Practice Location Address
First Line	:	10 MEADOWBROOK RD
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7122
Country	:	US
Telephone Number	:	817-683-2369
Fax Number	:	508-408-6192

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	01/07/2016

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Directions to “ KRISTEN OWENS ” Practice Location

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