Provider Demographics
NPI:1215300249
Name:OWENS, RODERICK
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 HAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6532
Mailing Address - Country:US
Mailing Address - Phone:318-226-5990
Mailing Address - Fax:318-226-5994
Practice Address - Street 1:1440 HAWN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107
Practice Address - Country:US
Practice Address - Phone:318-226-5990
Practice Address - Fax:318-226-5994
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist