Provider Demographics
NPI:1700329349
Name:OGDEN, ERICA GEAN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:GEAN
Last Name:OGDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BRITTANY CT
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1497
Mailing Address - Country:US
Mailing Address - Phone:618-504-0028
Mailing Address - Fax:
Practice Address - Street 1:11102 LINDBERGH BUSINESS CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7810
Practice Address - Country:US
Practice Address - Phone:314-604-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker