Provider Demographics
NPI:1043625783
Name:OGDEN, JOHN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:OGDEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 W BAGLEY PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5697
Mailing Address - Country:US
Mailing Address - Phone:801-282-1000
Mailing Address - Fax:801-282-1198
Practice Address - Street 1:5500 W BAGLEY PARK RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5697
Practice Address - Country:US
Practice Address - Phone:801-282-1000
Practice Address - Fax:801-282-1198
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT572476835011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical