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NPI Code Detail

MEDICARE: KATELYN M BOGGS

MEDICARE: KATELYN M BOGGS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor177495OH
2101YA0400XAddiction (Substance Use Disorder) Counselor186859OH

General Provider Information

NPI Number : 1396410122
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN M BOGGS
Provider Business Mailing Address
First Line : 520 SOLIDA RD
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-9347
Country : US
Telephone Number : 740-523-0097
Fax Number : 740-523-0049
Provider Business Practice Location Address
First Line : 520 SOLIDA RD
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-9347
Country : US
Telephone Number : 740-523-0097
Fax Number : 740-523-0049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2021
Last Update Date : 09/17/2024

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