Provider Demographics
NPI:1013288471
Name:OWEN, JODILYN (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:JODILYN
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 WILSON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2566
Mailing Address - Country:US
Mailing Address - Phone:206-261-2312
Mailing Address - Fax:
Practice Address - Street 1:5505 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3463
Practice Address - Country:US
Practice Address - Phone:206-261-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X, 176B00000X
WAMW 60268888176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay