Provider Demographics
NPI:1407043425
Name:BOOGAART, JUDY KAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:KAYE
Last Name:BOOGAART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5428
Mailing Address - Country:US
Mailing Address - Phone:616-990-5466
Mailing Address - Fax:
Practice Address - Street 1:560 STATE ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4828
Practice Address - Country:US
Practice Address - Phone:616-990-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical