Provider Demographics
NPI:1770197246
Name:BOGIE, KARINA J (LGSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:KARINA
Middle Name:J
Last Name:BOGIE
Suffix:
Gender:F
Credentials:LGSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1517
Mailing Address - Country:US
Mailing Address - Phone:612-235-4709
Mailing Address - Fax:612-872-8855
Practice Address - Street 1:1404 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1517
Practice Address - Country:US
Practice Address - Phone:612-235-4709
Practice Address - Fax:612-872-8855
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN291421041C0700X
MN305371101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical