Provider Demographics
NPI:1497188858
Name:BOGGS, JENNIFER U (LCSW, CADC I)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:U
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LCSW, CADC I
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ULLAKKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:NASELLE
Mailing Address - State:WA
Mailing Address - Zip Code:98638-0286
Mailing Address - Country:US
Mailing Address - Phone:503-994-6394
Mailing Address - Fax:503-386-2042
Practice Address - Street 1:10 PIER 1 STE 203
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-994-6394
Practice Address - Fax:503-386-2042
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-08-05101YA0400X
WALW 602972081041C0700X
ORL57671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)