Provider Demographics
NPI:1801187588
Name:FOGLEMAN, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FOGLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HENDERSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7374
Mailing Address - Country:US
Mailing Address - Phone:530-273-9541
Mailing Address - Fax:530-273-7740
Practice Address - Street 1:440 HENDERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7374
Practice Address - Country:US
Practice Address - Phone:530-273-9541
Practice Address - Fax:530-273-7740
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)