Provider Demographics
NPI:1942465760
Name:BOGNER, ANDREW RYAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RYAN
Last Name:BOGNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W. CENTRAL STE 106
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6302
Mailing Address - Country:US
Mailing Address - Phone:316-945-5200
Mailing Address - Fax:316-945-5549
Practice Address - Street 1:6700 W. CENTRAL STE 106
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6302
Practice Address - Country:US
Practice Address - Phone:316-945-5200
Practice Address - Fax:316-945-5549
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional