Provider Demographics
NPI:1336390780
Name:OWEN, LINDA GAYLE (MSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYLE
Last Name:OWEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 NORBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3843
Mailing Address - Country:US
Mailing Address - Phone:812-423-3601
Mailing Address - Fax:
Practice Address - Street 1:819 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1137
Practice Address - Country:US
Practice Address - Phone:812-491-1805
Practice Address - Fax:812-491-1929
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34007746A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1134206535OtherGROUP NPI
IN200529310AMedicaid
IN225590Medicare PIN