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NPI Code Detail

MEDICARE: JENNIFER BOGART

MEDICARE: JENNIFER BOGART
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
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1508404047
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BOGART
Provider Business Mailing Address
First Line : 6001 WHITEMAN DR NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2196
Country : US
Telephone Number : 505-717-1155
Fax Number :
Provider Business Practice Location Address
First Line : 6001 WHITEMAN DR NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2196
Country : US
Telephone Number : 505-717-1155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2019
Last Update Date : 01/08/2024

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Directions to “ JENNIFER BOGART ” Practice Location

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