Individual
CRYSTAL L BOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
438 E 40TH ST APT B, CHICAGO, IL 60653-4983
(773) 887-0729
Mailing address
438 E 40TH ST APT B, CHICAGO, IL 60653-4983
(773) 887-0729
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
126200888
IL
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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