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NPI Code Detail

MEDICARE: ALEXIS BOGAN

MEDICARE:   ALEXIS  BOGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100000220922OTHERWAAPPLE HEALTH

General Provider Information

NPI Number : 1043729676
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS BOGAN
Provider Business Mailing Address
First Line : 2312 E DENNY WAY APT D
Second Line :
City : SEATTLE
State : WA
Zip : 98122-2900
Country : US
Telephone Number : 831-295-4389
Fax Number :
Provider Business Practice Location Address
First Line : 2312 E DENNY WAY APT D
Second Line :
City : SEATTLE
State : WA
Zip : 98122-2900
Country : US
Telephone Number : 831-295-4389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2017
Last Update Date : 07/21/2022

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Directions to “ ALEXIS BOGAN ” Practice Location

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