Provider Demographics
NPI:1407190820
Name:BOGDAN, KAREN MANNING
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MANNING
Last Name:BOGDAN
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 1:314 W VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3760
Mailing Address - Country:US
Mailing Address - Phone:847-791-5794
Mailing Address - Fax:
Practice Address - Street 1:314 W VICTORIA LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3760
Practice Address - Country:US
Practice Address - Phone:847-791-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency