Healthcare Provider Details

I. General information

NPI: 1619049376
Provider Name (Legal Business Name): MARIAN FRANCES BOGENREIF LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAN BOGENREIF LAC

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 BROADWAY N STE 210
FARGO ND
58102-4943
US

IV. Provider business mailing address

31202 COUNTY HIGHWAY 27
FERGUS FALLS MN
56537-7326
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-5009
  • Fax: 218-736-5009
Mailing address:
  • Phone: 218-736-5009
  • Fax: 218-736-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number301516
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1290
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00064
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1657
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier19767
Identifier TypeOTHER
Identifier StateND
Identifier IssuerPROFESSIONAL COUNSELOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: