Healthcare Provider Details

I. General information

NPI: 1497733927
Provider Name (Legal Business Name): CAROLINE ELISABETH BOGEL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/29/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDRENS HEALTH CARE 345 N. SMITH AVE
ST. PAUL MN
55102
US

IV. Provider business mailing address

MEDDAC BAVARIA CMR 411
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7105
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: