Courtney Alexandra Bogardus, LMSW
Individual provider Active NPI Social Worker · Tempe, AZ
NPI 1639677354 · NPPES record last updated Oct 6, 2022
Key facts
- NPI
- 1639677354
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- LMSW-16967 (AZ)
- Practice address
- 2120 S McClintock Dr Ste 105
Tempe, AZ 85282-2692 - Phone
- (480) 804-0326
- Fax
- (480) 804-0083
- NPI assigned
- Jan 28, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| LMSW-16967 | AZ | MD | Social Worker |
| 6320 | OK | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6320 | OK | |
| Social Worker | 104100000X | LMSW-16967 | AZ | Yes |
Addresses
Primary practice location
2120 S McClintock Dr Ste 105
Tempe, AZ 85282-2692
Mailing address
1400 E Southern Ave Ste 735
Tempe, AZ 85282-5699
Phone (480) 804-0326
Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2022. 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.