Provider Demographics
NPI:1275006884
Name:BOGDANSKI, BROOKE GABRIEL (LSW)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:GABRIEL
Last Name:BOGDANSKI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:BROOKE
Other - Middle Name:GABRIEL
Other - Last Name:BOGDANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5695
Mailing Address - Fax:419-383-3031
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-5695
Practice Address - Fax:419-383-3031
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker