Provider Demographics
NPI:1629275524
Name:OGBURN, MICHELE D (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:D
Last Name:OGBURN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 MCKENNA RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-8454
Mailing Address - Country:US
Mailing Address - Phone:307-532-2017
Mailing Address - Fax:
Practice Address - Street 1:2009 LARAMIE ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1533
Practice Address - Country:US
Practice Address - Phone:307-532-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical