Provider Demographics
NPI:1114319001
Name:BOGDEN, ELEXIS
Entity Type:Individual
Prefix:MRS
First Name:ELEXIS
Middle Name:
Last Name:BOGDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 ARDEN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8630
Mailing Address - Country:US
Mailing Address - Phone:724-809-7517
Mailing Address - Fax:
Practice Address - Street 1:552 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-2848
Practice Address - Country:US
Practice Address - Phone:412-429-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst