Healthcare Provider Details

I. General information

NPI: 1629275524
Provider Name (Legal Business Name): MICHELE D OGBURN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 LARAMIE ST
TORRINGTON WY
82240-1533
US

IV. Provider business mailing address

4517 MCKENNA RD
TORRINGTON WY
82240-8454
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4181
  • Fax:
Mailing address:
  • Phone: 307-532-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number621
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: