Provider Demographics
NPI:1760742191
Name:OGDEN, ALLIA (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:ALLIA
Middle Name:
Last Name:OGDEN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 W AINSLIE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6155
Mailing Address - Country:US
Mailing Address - Phone:312-823-5912
Mailing Address - Fax:
Practice Address - Street 1:3915 W AINSLIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6155
Practice Address - Country:US
Practice Address - Phone:312-823-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0-19-10242106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst