Provider Demographics
NPI:1164493797
Name:BOGGESS, TAMARA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:L
Last Name:BOGGESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S PICKWICK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3339
Mailing Address - Country:US
Mailing Address - Phone:417-831-7999
Mailing Address - Fax:417-831-7989
Practice Address - Street 1:604 S PICKWICK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3339
Practice Address - Country:US
Practice Address - Phone:417-831-7999
Practice Address - Fax:417-831-7989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001522241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical