Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4331 | OH |
N | 103TC0700X | Clinical Psychologist | 4331 | OH |
N | 102L00000X | Psychologist | 4331 | OH |
N | 103T00000X | Psychologist | 4331 | OH |
Y | 103TR0400X | Rehabilitation Psychologist | 4331 | OH |
NPI | 1700896461 |
---|---|
Provider Name | Jennifer Bogner |
First Address | Dublin, OH 43017-7515 |
Second Address | Columbus, OH 43210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0843323 | (05) | OH |