Individual
KENNETH BOGGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
1 SERENITY LANE, COBURG, OR 97408
(541) 284-5695
Mailing address
PO BOX 8549, COBURG, OR 97408-1313
(541) 284-5695
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
161102
OR
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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