Healthcare Provider Details

I. General information

NPI: 1467770099
Provider Name (Legal Business Name): JANE B. OGDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 MANATEE AVE W SUITE B
BRADENTON FL
34209-2379
US

IV. Provider business mailing address

PO BOX 14309
BRADENTON FL
34280-4309
US

V. Phone/Fax

Practice location:
  • Phone: 941-713-5913
  • Fax:
Mailing address:
  • Phone: 941-713-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 9746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: