Provider Demographics
NPI:1770139792
Name:BOGER, SHANA (LMFT, CADC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:BOGER
Suffix:
Gender:F
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 100TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3851
Mailing Address - Country:US
Mailing Address - Phone:712-269-5610
Mailing Address - Fax:515-631-5193
Practice Address - Street 1:2900 100TH ST STE 207
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3851
Practice Address - Country:US
Practice Address - Phone:712-269-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist