Provider Demographics
NPI:1386932754
Name:BOGLIO, ALEXIS NICHOLE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:NICHOLE
Last Name:BOGLIO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4103
Mailing Address - Country:US
Mailing Address - Phone:602-218-8198
Mailing Address - Fax:602-606-9803
Practice Address - Street 1:300 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4103
Practice Address - Country:US
Practice Address - Phone:602-218-8198
Practice Address - Fax:602-606-9803
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1118830103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst