Healthcare Provider Details

I. General information

NPI: 1962315358
Provider Name (Legal Business Name): CHAD JEREMY BOGDEWIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 BANKSVILLE RD
PITTSBURGH PA
15216-2812
US

IV. Provider business mailing address

421 FLORENCE AVE APT 2
PITTSBURGH PA
15202-2314
US

V. Phone/Fax

Practice location:
  • Phone: 866-583-6003
  • Fax:
Mailing address:
  • Phone: 412-292-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008787
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: