Provider Demographics
NPI:1194831180
Name:BOGUE, CATHERINE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
Last Name:BOGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18910 E 37TH TER S APT 1
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2398
Mailing Address - Country:US
Mailing Address - Phone:816-863-3102
Mailing Address - Fax:
Practice Address - Street 1:4104 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2307
Practice Address - Country:US
Practice Address - Phone:816-863-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0036071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical