MEDICARE: KIMBERLY SUE OGLESBY LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	306288	MN

General Provider Information

NPI Number	:	1841038999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUE OGLESBY LADC

Provider Business Mailing Address
First Line	:	331 KATHRYN CT
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2528
Country	:	US
Telephone Number	:	715-220-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 KATHRYN CT
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2528
Country	:	US
Telephone Number	:	715-220-7417
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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Directions to “ KIMBERLY SUE OGLESBY LADC” Practice Location

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