Provider Demographics
NPI:1063148724
Name:OGDEN, MELISSA G (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:OGDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 BROWN THRASHER LOOP N
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3052
Mailing Address - Country:US
Mailing Address - Phone:985-630-4440
Mailing Address - Fax:
Practice Address - Street 1:1405 HIGHWAY 1088
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6214
Practice Address - Country:US
Practice Address - Phone:985-626-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist