1609213164 NPI number — CHARLENE BOGLE RISIEN LCDC, AAC, CCJP, CSA

Table of content: CHARLENE BOGLE RISIEN LCDC, AAC, CCJP, CSA (NPI 1609213164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609213164 NPI number — CHARLENE BOGLE RISIEN LCDC, AAC, CCJP, CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISIEN
Provider First Name:
CHARLENE
Provider Middle Name:
BOGLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDC, AAC, CCJP, CSA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RISIEN
Provider Other First Name:
CHARLIE
Provider Other Middle Name:
B.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCDC, AAC, CCJP, CSA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609213164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 N.E. LOOP 410
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-392-3788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 N.E. LOOP 410
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-392-3788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  7750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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