Provider Demographics
NPI:1104054808
Name:OGLESBY, CAROL ANN (BA, MS/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:BA, MS/CCC/SLP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ZIMMERMAN
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:277 LINFIELD LN SW
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-9621
Mailing Address - Country:US
Mailing Address - Phone:601-384-4854
Mailing Address - Fax:
Practice Address - Street 1:481 HIGHWAY 98 E
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-7378
Practice Address - Country:US
Practice Address - Phone:601-384-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist