Healthcare Provider Details

I. General information

NPI: 1528216348
Provider Name (Legal Business Name): JEAN L. OGBURN M.A., C.C.C., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TOM BELL RD STE C
MURPHYS CA
95247-9585
US

IV. Provider business mailing address

245 TOM BELL RD STE C
MURPHYS CA
95247-9585
US

V. Phone/Fax

Practice location:
  • Phone: 209-728-0744
  • Fax: 209-728-0125
Mailing address:
  • Phone: 209-728-0744
  • Fax: 209-728-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: