Individual
DANA ALEXZANDRIA BOGDANOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-8200
Mailing address
220 W RAPP RD UNIT 113, TALENT, OR 97540-8676
(541) 324-2134
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
NA
OR
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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