Healthcare Provider Details

I. General information

NPI: 1235069519
Provider Name (Legal Business Name): CLARICE DANIELLE OGLESBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 E CLINTON AVE 105
FRESNO CA
93703
UM

IV. Provider business mailing address

2600 E CLINTON AVE APT 105
FRESNO CA
93703-2463
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 559-727-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: