Healthcare Provider Details

I. General information

NPI: 1871119339
Provider Name (Legal Business Name): MEGAN OGBEBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 CENTENNIAL BLVD STE 2
SPRINGFIELD OR
97477-3320
US

IV. Provider business mailing address

1705 CENTENNIAL BLVD STE 2
SPRINGFIELD OR
97477-3320
US

V. Phone/Fax

Practice location:
  • Phone: 541-818-0009
  • Fax:
Mailing address:
  • Phone: 541-818-0009
  • Fax: 541-780-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL16792
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: