Provider Demographics
NPI:1992478143
Name:BOGIE, SARA ANN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:BOGIE
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 1:930 DOUGLAS ST APT 228
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4321
Mailing Address - Country:US
Mailing Address - Phone:949-973-8742
Mailing Address - Fax:
Practice Address - Street 1:1530 1ST AVE N # 150
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2278
Practice Address - Country:US
Practice Address - Phone:218-309-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician