Healthcare Provider Details

I. General information

NPI: 1518634591
Provider Name (Legal Business Name): KRISTEN OGDEN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 MURPHY ST
SHREVEPORT LA
71103-2549
US

IV. Provider business mailing address

1021 TOWHEE DR
SHREVEPORT LA
71106-8434
US

V. Phone/Fax

Practice location:
  • Phone: 318-603-6800
  • Fax:
Mailing address:
  • Phone: 318-465-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3856
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: