Provider Demographics
NPI:1932259215
Name:OGDEN, MELISSA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:OGDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:OGDEN
Other - Last Name:EPKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2450 OLD SHELL ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3020
Mailing Address - Country:US
Mailing Address - Phone:251-478-3044
Mailing Address - Fax:251-476-9055
Practice Address - Street 1:2450 OLD SHELL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3020
Practice Address - Country:US
Practice Address - Phone:251-478-3044
Practice Address - Fax:251-476-9055
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1108103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP18494Medicare UPIN
AL051554267Medicare ID - Type UnspecifiedMEDICARE