Provider Demographics
NPI:1528216348
Name:OGBURN, JEAN L (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:OGBURN
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 TOM BELL RD
Mailing Address - Street 2:STE C
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-9585
Mailing Address - Country:US
Mailing Address - Phone:209-728-0744
Mailing Address - Fax:209-728-0125
Practice Address - Street 1:245 TOM BELL RD
Practice Address - Street 2:STE C
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247-9585
Practice Address - Country:US
Practice Address - Phone:209-728-0744
Practice Address - Fax:209-728-0125
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056847Medicare PIN