MEDICARE: DONNA OGLESBY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588105779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA OGLESBY

Provider Business Mailing Address
First Line	:	4820 NE HAZEL DELL AVE
Second Line	:	APT 811
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 NE MLK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2941
Country	:	US
Telephone Number	:	503-232-1099
Fax Number	:

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	03/20/2017

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Directions to “ DONNA OGLESBY ” Practice Location

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