Provider Demographics
NPI:1619418092
Name:BOGGS, KATHRYN THOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THOR
Last Name:BOGGS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 S SHARON AMITY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2866
Mailing Address - Country:US
Mailing Address - Phone:859-227-9922
Mailing Address - Fax:
Practice Address - Street 1:1421 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1059
Practice Address - Country:US
Practice Address - Phone:859-624-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130312103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist