Provider Demographics
NPI:1285965442
Name:OGLE, JEANNINE THERESE (DN)
Entity type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:THERESE
Last Name:OGLE
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N LARKIN AVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1970
Mailing Address - Country:US
Mailing Address - Phone:815-744-5533
Mailing Address - Fax:
Practice Address - Street 1:1701 N LARKIN AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1970
Practice Address - Country:US
Practice Address - Phone:815-744-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181-000115175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath