Provider Demographics
NPI:1932662632
Name:KATIE BOGACKI, LCSW, LLC
Entity Type:Organization
Organization Name:KATIE BOGACKI, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-968-9691
Mailing Address - Street 1:4801 W PETERSON AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5726
Mailing Address - Country:US
Mailing Address - Phone:773-968-9691
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE STE 308
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5726
Practice Address - Country:US
Practice Address - Phone:773-968-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760938260OtherCMS