Provider Demographics
NPI:1184118150
Name:BOGAERT, NIKA SABA (LCSW)
Entity type:Individual
Prefix:
First Name:NIKA
Middle Name:SABA
Last Name:BOGAERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NIKA
Other - Middle Name:SABA
Other - Last Name:NADDAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3720 S BOND AVE UNIT 1618
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4575
Mailing Address - Country:US
Mailing Address - Phone:858-947-8875
Mailing Address - Fax:
Practice Address - Street 1:808 SW CAMPUS DR # 14115
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3008
Practice Address - Country:US
Practice Address - Phone:503-346-1456
Practice Address - Fax:503-346-1457
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL118961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical