| Mary Bogle Psy D Llc | |
|
11630 Se 40th Ave Ste A Milwaukie OR 97222-6195 | |
| (503) 303-3740 | |
| Not Available |
| Full Name | Mary Bogle Psy D Llc |
|---|---|
| Speciality | Psychologist |
| Location | 11630 Se 40th Ave Ste A, Milwaukie, Oregon |
| Authorized Official Name and Position | Mary Bogle (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5033033740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Bogle Psy D Llc 5111 Se Lake Rd Milwaukie OR 97222-4767 Ph: () - | Mary Bogle Psy D Llc 11630 Se 40th Ave Ste A Milwaukie OR 97222-6195 Ph: (503) 303-3740 |
| NPI Number | 1881325892 |
|---|---|
| Provider Enumeration Date | 06/21/2022 |
| Last Update Date | 09/28/2023 |
| Certification Date | 09/28/2023 |
| Medicare PECOS PAC ID | 2264800184 |
|---|---|
| Medicare Enrollment ID | O20221128002192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881325892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary K J Bogle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083744536 PECOS PAC ID: 7517186240 Enrollment ID: I20200121002636 |
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