Provider Demographics
NPI:1619049376
Name:BOGENREIF, MARIAN FRANCES (LADC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:FRANCES
Last Name:BOGENREIF
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:BOGENREIF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:31202 COUNTY HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-7326
Mailing Address - Country:US
Mailing Address - Phone:218-736-5009
Mailing Address - Fax:218-736-5009
Practice Address - Street 1:118 BROADWAY N STE 210
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4943
Practice Address - Country:US
Practice Address - Phone:218-736-5009
Practice Address - Fax:218-736-5009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301516101YA0400X
ND1290101YA0400X
MN00064104100000X
ND1657104100000X
ND101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19767OtherPROFESSIONAL COUNSELOR