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NPI Code Detail

MEDICARE: CASSONDRA A OGLESBY LBA

MEDICARE: CASSONDRA A OGLESBY LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst2025006538MO

General Provider Information

NPI Number : 1811312036
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSONDRA A OGLESBY LBA
Provider Business Mailing Address
First Line : 686 LESTER ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5025
Country : US
Telephone Number : 573-686-1200
Fax Number :
Provider Business Practice Location Address
First Line : 686 LESTER ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5025
Country : US
Telephone Number : 573-686-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2014
Last Update Date : 12/08/2025

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Directions to “ CASSONDRA A OGLESBY LBA” Practice Location

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