Provider Demographics
NPI:1124222195
Name:BOGGS, KIMBERLY A (LISW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 E GAY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3229
Mailing Address - Country:US
Mailing Address - Phone:614-221-5891
Mailing Address - Fax:614-228-1125
Practice Address - Street 1:6631 COMMERCE PKWY STE R
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3239
Practice Address - Country:US
Practice Address - Phone:614-360-2600
Practice Address - Fax:443-202-6008
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100087071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical