Provider Demographics
NPI:1285038620
Name:BOGOTT, DANIELA KEREKRETYOVA (MA, LAMFT,)
Entity Type:Individual
Prefix:MRS
First Name:DANIELA
Middle Name:KEREKRETYOVA
Last Name:BOGOTT
Suffix:
Gender:F
Credentials:MA, LAMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 231D
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3000
Mailing Address - Country:US
Mailing Address - Phone:612-212-3564
Mailing Address - Fax:
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 231D
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3000
Practice Address - Country:US
Practice Address - Phone:612-212-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist