Basic Information
| Provider Information | |||||||||
| NPI: | 1114063211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OGLESBY | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | SULLIVAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4692 HIGHWAY 84 W | ||||||||
| Address2: | |||||||||
| City: | MEADVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396538465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013845503 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 711 AVIGNON DR | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391575120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016056777 | ||||||||
| FaxNumber: | 6016058869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | S0620 | MS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.