Healthcare Provider Details

I. General information

NPI: 1205767811
Provider Name (Legal Business Name): MELISA OGRIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TOWER PARK DR
WATERLOO IA
50701-9027
US

IV. Provider business mailing address

1808 COACHMAN DR
WATERLOO IA
50701-1709
US

V. Phone/Fax

Practice location:
  • Phone: 319-242-7642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-503111
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: