Provider Demographics
NPI:1811148489
Name:BOGDAN, KATHLEEN M (MS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KUKUI GROVE STREET
Mailing Address - Street 2:SUITE 3-211
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-274-3190
Mailing Address - Fax:808-274-3194
Practice Address - Street 1:4370 KUKUI GROVE STREET
Practice Address - Street 2:SUITE 3-211
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-274-3190
Practice Address - Fax:808-274-3194
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539372-01Medicaid
HIKCMHMedicare UPIN