Provider Demographics
NPI:1649266693
Name:OGLE, ROSE INGRAM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:INGRAM
Last Name:OGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:INGRAM
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-534-7028
Practice Address - Street 1:213 E ORANGE ST
Practice Address - Street 2:STE B
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-2934
Practice Address - Country:US
Practice Address - Phone:863-773-3228
Practice Address - Fax:863-534-7028
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW28701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ955OtherBCBS
FL763558300Medicaid
455343000OtherMAGELLAN
455343000OtherMAGELLAN