Healthcare Provider Details

I. General information

NPI: 1417548694
Provider Name (Legal Business Name): DENISE LYN OGBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702-130 RICHMOND RD E
SUSANVILLE CA
96130-5029
US

IV. Provider business mailing address

PO BOX 3940
QUINCY CA
95971-3940
US

V. Phone/Fax

Practice location:
  • Phone: 530-257-5644
  • Fax:
Mailing address:
  • Phone: 530-283-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: