Provider Demographics
NPI:1740815315
Name:OGILVIE, LIVVIE VON
Entity type:Individual
Prefix:
First Name:LIVVIE
Middle Name:VON
Last Name:OGILVIE
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 1:7 VIKING WAY
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-9308
Mailing Address - Country:US
Mailing Address - Phone:360-208-4294
Mailing Address - Fax:
Practice Address - Street 1:2570 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-4928
Practice Address - Country:US
Practice Address - Phone:360-581-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB1034221106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician