Healthcare Provider Details

I. General information

NPI: 1568974400
Provider Name (Legal Business Name): ELIZABETH OGREN SLP-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E MARTIN LUTHER KING JR BLVD
AUSTIN TX
78702-1342
US

IV. Provider business mailing address

6701 BURNET RD
AUSTIN TX
78757-2855
US

V. Phone/Fax

Practice location:
  • Phone: 512-900-7934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number113520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: