Provider Demographics
NPI:1598812653
Name:OGREN, DAVID J (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:OGREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 OSMUNDSEN RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5138
Mailing Address - Country:US
Mailing Address - Phone:608-609-6709
Mailing Address - Fax:608-238-3159
Practice Address - Street 1:2916 MARKETPLACE DR
Practice Address - Street 2:STE 212
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5325
Practice Address - Country:US
Practice Address - Phone:608-609-6709
Practice Address - Fax:608-238-3159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2680-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical