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NPI Code Detail

MEDICARE: MRS. JOY LEE OGDEN CADC II

MEDICARE: MRS. JOY LEE OGDEN CADC II
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1720150808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOY LEE OGDEN CADC II
Provider Business Mailing Address
First Line : 313 E TABOR AVE APT 10
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-3973
Country : US
Telephone Number : 707-435-8042
Fax Number : 707-435-1527
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-8042
Fax Number : 707-435-1527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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