Provider Demographics
NPI:1023160868
Name:OWEN, VANESSA L (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:OWEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 B AVENUE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034
Mailing Address - Country:US
Mailing Address - Phone:503-516-6085
Mailing Address - Fax:
Practice Address - Street 1:201 B AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3159
Practice Address - Country:US
Practice Address - Phone:503-516-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL36211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20-8067832OtherEIN