Keith David Bogucki, LLMSW
Individual provider Active NPI Clinical Social Worker · White Cloud, MI
NPI 1306347356 · NPPES record last updated Feb 26, 2018
Key facts
- NPI
- 1306347356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801101915 (MI)
- Practice address
- 1049 Newell
P.O. Box 867
White Cloud, MI 49349 - Phone
- (231) 689-7330
- NPI assigned
- Feb 26, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801101915 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newaygo County Mental Health Board | Past | Accepting new patients | |
| Newaygo County Mental Health Board | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801101915 | MI | Yes |
Addresses
Primary practice location
1049 Newell
P.O. Box 867
White Cloud, MI 49349
Mailing address
1049 E Newell St
White Cloud, MI 49349-8795
Phone (231) 689-7330
Other providers in White Cloud, MI
- Jerren Benton
- Amber Lynne Bergman
- Jenniffer Bignall
- Annette Binnendyk
- Andrea Leigh Bliss
- Katerina Bremer
- Chris P Briggs
- John George Briggs
- Lisa Marie Briggs
- Kristin E Brookhouse
All providers in White Cloud, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.