Provider Demographics
NPI:1144611435
Name:BOGERT, SHAUNA LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:LYNN
Last Name:BOGERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 CALLE MIRADOR UPPR
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4628
Mailing Address - Country:US
Mailing Address - Phone:949-280-4185
Mailing Address - Fax:
Practice Address - Street 1:1411 CALLE MIRADOR UPPR
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4628
Practice Address - Country:US
Practice Address - Phone:949-280-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency