Provider Demographics
NPI:1396060968
Name:OGDEN, MARY LYNN (MSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:OGDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:RAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1506 E. BROADWAY SUITE 119
Mailing Address - Street 2:EMPLOYEE ASSISTANCE PROGRAM DOCTOR'S BUILDING
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-815-6034
Mailing Address - Fax:573-815-6477
Practice Address - Street 1:1506 E. BROADWAY SUITE 119
Practice Address - Street 2:EMPLOYEE ASSISTANCE PROGRAM DOCTOR'S BUILDING
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-815-6034
Practice Address - Fax:573-815-6477
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001796104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker