Provider Demographics
NPI:1932546413
Name:BOGG, JENNIFER R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:BOGG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:409 PLYMOUTH RD STE 270
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1842
Mailing Address - Country:US
Mailing Address - Phone:248-758-8022
Mailing Address - Fax:
Practice Address - Street 1:409 PLYMOUTH RD STE 270
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1842
Practice Address - Country:US
Practice Address - Phone:248-758-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010941571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical