Kenneth Boggie, CADC I

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

161102 Issued in OR

Practice address

1 Serenity Lane
Coburg, OR 97408

Phone

(541) 284-5695

NPI assigned

Mar 2, 2017

Last updated

Mar 2, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1467283069
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488412800000",
    "number": "1689114175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8549",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974081313",
            "telephone_number": "541-284-5695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SERENITY LANE",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "97408",
            "telephone_number": "541-284-5695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGIE",
        "first_name": "KENNETH",
        "credential": "CADC I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-02",
        "last_updated": "2017-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "161102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisha Marie Bashor
• Daniel John Bates I
• Jason Bernal
• Brandy Lynn Blackwell, CADC 1
• Sharon Mary Blanchard
• Hannah Boissier, LMT
• Christopher Bowling
• Mark Brauer
• Sarah Rachel Brown
• Hannah Brumbaugh-Cunningham

• Addiction (Substance Use Disorder) Counselor in Coburg, OR
• Providers in Coburg, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.