Healthcare Provider Details

I. General information

NPI: 1912210311
Provider Name (Legal Business Name): JEANICE MARIE KNIGHT-BOGATZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 LOGAN VALLEY RD
TRAVERSE CITY MI
49684-4772
US

IV. Provider business mailing address

3155 LOGAN VALLEY RD
TRAVERSE CITY MI
49684-4772
US

V. Phone/Fax

Practice location:
  • Phone: 402-677-9083
  • Fax:
Mailing address:
  • Phone: 402-677-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401017335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: