Provider Demographics
NPI:1952035933
Name:OHLGREN, TERENCE
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:OHLGREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1376
Mailing Address - Country:US
Mailing Address - Phone:320-815-2742
Mailing Address - Fax:
Practice Address - Street 1:619 2ND ST W
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1376
Practice Address - Country:US
Practice Address - Phone:320-815-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1113399253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency