Provider Demographics
NPI:1972373488
Name:BOGENRIEF, JORDAN SCOTT (LPC SUPERVISEE)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SCOTT
Last Name:BOGENRIEF
Suffix:
Gender:M
Credentials:LPC SUPERVISEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2003
Mailing Address - Country:US
Mailing Address - Phone:605-697-3002
Mailing Address - Fax:
Practice Address - Street 1:418 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2003
Practice Address - Country:US
Practice Address - Phone:605-697-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20859101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor