Healthcare Provider Details

I. General information

NPI: 1245605831
Provider Name (Legal Business Name): LAUREN ELIZABETH OGANOVICH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10522 S CICERO AVE SUITE 401
OAK LAWN IL
60453-5200
US

IV. Provider business mailing address

10522 S CICERO AVE SUITE 401
OAK LAWN IL
60453-5200
US

V. Phone/Fax

Practice location:
  • Phone: 708-942-7279
  • Fax:
Mailing address:
  • Phone: 708-942-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009183
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: