Provider Demographics
NPI:1023157856
Name:OWEN, W. LEANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:W.
Middle Name:LEANNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 VALLEYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1233
Mailing Address - Country:US
Mailing Address - Phone:509-758-9141
Mailing Address - Fax:
Practice Address - Street 1:510 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2669
Practice Address - Country:US
Practice Address - Phone:509-780-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014090171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor