Provider Demographics
NPI:1710548029
Name:OGLETREE, TANESHA ALTHEA (LCSW)
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:ALTHEA
Last Name:OGLETREE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANESHA
Other - Middle Name:ALTHEA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4745 S SAINT LAWRENCE AVE # 3N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1507
Mailing Address - Country:US
Mailing Address - Phone:773-771-1070
Mailing Address - Fax:
Practice Address - Street 1:4745 S SAINT LAWRENCE AVE # 3N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-1507
Practice Address - Country:US
Practice Address - Phone:773-771-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical