Healthcare Provider Details

I. General information

NPI: 1134370737
Provider Name (Legal Business Name): ELIZABETH A OGREN AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOPE AVE
WALTHAM MA
02453-2741
US

IV. Provider business mailing address

9 HOPE AVE
WALTHAM MA
02453-2741
US

V. Phone/Fax

Practice location:
  • Phone: 781-216-2238
  • Fax: 781-216-2252
Mailing address:
  • Phone: 781-216-2238
  • Fax: 781-216-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSP-0901-AU
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: