Provider Demographics
NPI:1417135013
Name:MOGENSEN, ELENA K (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:K
Last Name:MOGENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:THEOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-0777
Mailing Address - Country:US
Mailing Address - Phone:970-878-9935
Mailing Address - Fax:970-878-9970
Practice Address - Street 1:685 MAIN ST.
Practice Address - Street 2:STE. 5-B
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641
Practice Address - Country:US
Practice Address - Phone:970-878-9935
Practice Address - Fax:970-878-9970
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO988005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89691Medicare PIN