MEDICARE: MISS CHIQUITA OGLESBY LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150109351	IL

General Provider Information

NPI Number	:	1265387740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHIQUITA OGLESBY LSW

Provider Business Mailing Address
First Line	:	495 DEVONSHIRE DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61820-7295
Country	:	US
Telephone Number	:	217-904-3035
Fax Number	:	217-904-3035

Provider Business Practice Location Address
First Line	:	7 E FAIRCHILD ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3140
Country	:	US
Telephone Number	:	217-904-3035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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