Provider Demographics
NPI:1023289154
Name:OWEN, KRISTINE EDWENNA (AUD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:EDWENNA
Last Name:OWEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:DEPT. OF OTOLARYNGOLOGY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-645-8898
Mailing Address - Fax:214-648-9122
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:DEPT. OF OTOLARYNGOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-8898
Practice Address - Fax:214-648-9122
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50903231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist