Provider Demographics
NPI:1033425988
Name:BOGENSCHNEIDER, DAPHNE LYNN (LCPC, LSOTP, LSOE)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:LYNN
Last Name:BOGENSCHNEIDER
Suffix:
Gender:F
Credentials:LCPC, LSOTP, LSOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E BETHEL DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1456
Mailing Address - Country:US
Mailing Address - Phone:815-939-1900
Mailing Address - Fax:815-939-1902
Practice Address - Street 1:183 E BETHEL DR
Practice Address - Street 2:KEYSTONE COUNSELING
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1456
Practice Address - Country:US
Practice Address - Phone:815-939-1900
Practice Address - Fax:815-939-1902
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005982101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health