Healthcare Provider Details

I. General information

NPI: 1598580201
Provider Name (Legal Business Name): TIFFANY OGDEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOREST ST N
SAINT PAUL MN
55106
US

IV. Provider business mailing address

5210 GLENDALE ST
SAINT PAUL MN
55104
US

V. Phone/Fax

Practice location:
  • Phone: 651-444-5880
  • Fax:
Mailing address:
  • Phone: 651-444-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17012
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: