Provider Demographics
NPI:1447035050
Name:OWENS, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4003
Mailing Address - Country:US
Mailing Address - Phone:509-593-8122
Mailing Address - Fax:509-769-5221
Practice Address - Street 1:1933 JADWIN AVE STE 120
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2280
Practice Address - Country:US
Practice Address - Phone:509-593-8122
Practice Address - Fax:509-769-5221
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical