Provider Demographics
NPI:1215177118
Name:BOGAR, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BOGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENTON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1266
Mailing Address - Country:US
Mailing Address - Phone:304-347-9818
Mailing Address - Fax:304-347-9820
Practice Address - Street 1:300 KENTON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1266
Practice Address - Country:US
Practice Address - Phone:304-347-9818
Practice Address - Fax:304-347-9820
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid