MEDICARE: MS. LATOYA TENEKA OWENS MSW

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	1610G	AL

General Provider Information

NPI Number	:	1801856596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATOYA TENEKA OWENS MSW

Provider Business Mailing Address
First Line	:	2201 48TH ST E
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-5851
Country	:	US
Telephone Number	:	205-633-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 LOOP RD
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5015
Country	:	US
Telephone Number	:	205-554-2000
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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