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NPI Code Detail

MEDICARE: INDIA VIANCA OWEN

MEDICARE: INDIA VIANCA OWEN
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
11041C0700XClinical Social Worker6851121457MI

General Provider Information

NPI Number : 1508712167
Entity Type Code : Individual
Provider Name (Legal Business Name) : INDIA VIANCA OWEN
Provider Business Mailing Address
First Line : 9617 ASBURY PARK
Second Line :
City : DETROIT
State : MI
Zip : 48227-1068
Country : US
Telephone Number : 313-516-3196
Fax Number :
Provider Business Practice Location Address
First Line : 19750 BURT RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-2078
Country : US
Telephone Number : 313-531-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ INDIA VIANCA OWEN ” Practice Location

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