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Individual

MS. JEAN LAVONNE OGILVIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LLP

Contact information

Practice address
8036 MOORSBRIDGE ROAD, SUITE #2, PORTAGE, MI 49024-4417
(269) 327-1438
(269) 327-6454
Mailing address
PO BOX 2585, PORTAGE, MI 49081-2585
(269) 381-0150
(269) 373-4720

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301009676
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
08913870
BLUE CROSS BLUE SHIELD
01
0C910880
PROFESSIONAL NUMBER
Enumeration date
09/27/2006
Last updated
07/08/2007
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