Provider Demographics
NPI:1396410122
Name:BOGGS, KATELYN M
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:M
Last Name:BOGGS
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 1:520 SOLIDA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9347
Mailing Address - Country:US
Mailing Address - Phone:740-523-0097
Mailing Address - Fax:740-523-0049
Practice Address - Street 1:520 SOLIDA RD
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9347
Practice Address - Country:US
Practice Address - Phone:740-523-0097
Practice Address - Fax:740-523-0049
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177495101YA0400X
OH186859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)