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General NPI Number Information
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NPI Number | 1598812653
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Entity Type | Individual
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Provider Name | DAVID J OGREN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2916 MARKETPLACE DR STE 212
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City | FITCHBURG
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State | WI
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Zip | 53719-5325
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Country | US
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Telephone | 608-609-6709
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Fax | 608-238-3159
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Provider Business Mailing Address
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Address Line | 2840 OSMUNDSEN RD
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City | FITCHBURG
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State | WI
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Zip | 53711-5138
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Country | US
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Telephone | 608-609-6709
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Fax | 608-238-3159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2680-057
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License Number State | WI
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