Provider Demographics
NPI:1174894950
Name:OGLESBY, MARY (BS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3004
Mailing Address - Country:US
Mailing Address - Phone:985-446-5244
Mailing Address - Fax:985-446-5478
Practice Address - Street 1:102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3004
Practice Address - Country:US
Practice Address - Phone:985-446-5244
Practice Address - Fax:985-446-5478
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker