Provider Demographics
NPI:1760736128
Name:DR. JENNIFER E. BOGUS
Entity Type:Organization
Organization Name:DR. JENNIFER E. BOGUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOGUS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-347-2163
Mailing Address - Street 1:29020 SW TOWN CENTER LOOP E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9489
Mailing Address - Country:US
Mailing Address - Phone:503-682-1110
Mailing Address - Fax:503-433-1925
Practice Address - Street 1:29020 SW TOWN CENTER LOOP E
Practice Address - Street 2:SUITE 100
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9489
Practice Address - Country:US
Practice Address - Phone:503-682-1110
Practice Address - Fax:503-433-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1675175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty