Provider Demographics
NPI:1730502501
Name:BOGERT, STEPHEN (L AC, CH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BOGERT
Suffix:
Gender:M
Credentials:L AC, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 KEY ST
Mailing Address - Street 2:STE 106
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5232
Mailing Address - Country:US
Mailing Address - Phone:360-756-9793
Mailing Address - Fax:360-752-9007
Practice Address - Street 1:1116 KEY ST
Practice Address - Street 2:STE 106
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5232
Practice Address - Country:US
Practice Address - Phone:360-756-9793
Practice Address - Fax:360-752-9007
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60437922171100000X
WAHP60239225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor