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General NPI Number Information
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NPI Number | 1265770523
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Entity Type | Individual
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Provider Name | CHARLES HERMANN BOGDAHN LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/08/2023
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Provider Practice Location Address
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Address Line | 1419 EAST COLLEGE WAY
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City | MOUNT VERNON
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State | WA
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Zip | 98273
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Country | US
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Telephone | 808-688-3376
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Fax | 808-961-6819
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Provider Business Mailing Address
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Address Line | PO BOX 591
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City | PEPEEKEO
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State | HI
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Zip | 96783
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Country | US
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Telephone | 808-688-3376
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Fax | 808-961-6819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | #615
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License Number State | HI
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