Provider Demographics
NPI:1891129029
Name:BOGNER, SHANNAN ZELL (BHT)
Entity Type:Individual
Prefix:MS
First Name:SHANNAN
Middle Name:ZELL
Last Name:BOGNER
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:MS
Other - First Name:SHANNAN
Other - Middle Name:
Other - Last Name:ZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHT
Mailing Address - Street 1:795 SUNSET BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3699
Mailing Address - Country:US
Mailing Address - Phone:406-260-4181
Mailing Address - Fax:
Practice Address - Street 1:3825 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6512
Practice Address - Country:US
Practice Address - Phone:602-955-7997
Practice Address - Fax:602-954-0980
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator