Basic Information
| Provider Information | |||||||||
| NPI: | 1194005009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGART | ||||||||
| FirstName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 976 E WALNUT RD | ||||||||
| Address2: | |||||||||
| City: | WYMORE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 684668013 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 S 42ND ST | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025533000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 489 | NE | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.