Provider Demographics
NPI:1841038999
Name:OGLESBY, KIMBERLY SUE (LADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 KATHRYN CT
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2528
Mailing Address - Country:US
Mailing Address - Phone:715-220-7417
Mailing Address - Fax:
Practice Address - Street 1:331 KATHRYN CT
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2528
Practice Address - Country:US
Practice Address - Phone:715-220-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)