Healthcare Provider Details

I. General information

NPI: 1881841997
Provider Name (Legal Business Name): ROSEANNA MARIE OGAN MSW, LCSW, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 E. DAKOTA
PIERRA SD
57501-0148
US

IV. Provider business mailing address

PO BOX 148
PIERRA SD
57501-0148
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5811
  • Fax: 605-224-6921
Mailing address:
  • Phone: 605-224-5811
  • Fax: 605-224-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2325
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: