Provider Demographics
NPI:1366120131
Name:BOGAN-EL, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BOGAN-EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3687
Mailing Address - Country:US
Mailing Address - Phone:267-997-4923
Mailing Address - Fax:
Practice Address - Street 1:301 OLD DUPONT RD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1084
Practice Address - Country:US
Practice Address - Phone:302-503-2273
Practice Address - Fax:302-351-6830
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health