Provider Demographics
NPI:1265770523
Name:BOGDAHN, CHARLES HERMANN (LCSW)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HERMANN
Last Name:BOGDAHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:PEPEEKEO
Mailing Address - State:HI
Mailing Address - Zip Code:96783
Mailing Address - Country:US
Mailing Address - Phone:808-688-3376
Mailing Address - Fax:808-961-6819
Practice Address - Street 1:1419 EAST COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:808-688-3376
Practice Address - Fax:808-961-6819
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI#615103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent