Healthcare Provider Details

I. General information

NPI: 1538429519
Provider Name (Legal Business Name): DINA MARIE BOGGS MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N. HIGH ST SUITE 300
COLUMBUS OH
43214
US

IV. Provider business mailing address

4400 N. HIGH ST SUITE 300
COLUMBUS OH
43214
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-2437
  • Fax: 614-291-7163
Mailing address:
  • Phone: 614-299-2437
  • Fax: 614-291-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1000409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: