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Individual
MR. JESSE LEE OWENS
Active
Individual
MR. JESSE LEE OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-007440
IL
1041S0200X
School Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634638
BCBS OF ILLINOIS
IL
01
—
810323000
MAGELLAN BEHAVIORAL HEALTH
IL
Enumeration date
08/30/2005
Last updated
10/10/2017
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