Provider Demographics
NPI:1063735355
Name:OZENBERGER, ALICIA J (MED)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:J
Last Name:OZENBERGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SUMMERTIME DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-1117
Mailing Address - Country:US
Mailing Address - Phone:573-864-1113
Mailing Address - Fax:
Practice Address - Street 1:601 W NIFONG BLVD
Practice Address - Street 2:BLDG 5A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6804
Practice Address - Country:US
Practice Address - Phone:573-214-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015577101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor