Individual
MRS. JAN C BOGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4656 W JEFFERSON BLVD, SUITE 285, FORT WAYNE, IN 46804-6857
(260) 422-9372
(260) 422-0843
Mailing address
20 GROVE PARK DR, COLUMBIA CITY, IN 46725-1812
(260) 249-8429
(260) 244-1983
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000520A
IN
1041C0700X
Clinical Social Worker
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200532500A
—
IN
Enumeration date
12/04/2006
Last updated
02/05/2018
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