Provider Demographics
NPI:1215001706
Name:OWEN, BARBARA E (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:OWEN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 123 R AVE SE
Mailing Address - Street 2:
Mailing Address - City:LUREME
Mailing Address - State:ND
Mailing Address - Zip Code:58056
Mailing Address - Country:US
Mailing Address - Phone:701-845-0680
Mailing Address - Fax:
Practice Address - Street 1:SHEYENNE CARE CENTER
Practice Address - Street 2:979 NO CENTRAL AVE
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072
Practice Address - Country:US
Practice Address - Phone:701-845-8222
Practice Address - Fax:701-845-6277
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25398OtherB BS
ND57576Medicaid
ND23641OtherB BS