Provider Demographics
NPI:1275596058
Name:BOGGS, PAULA C (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:C
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 MONTREAL LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8420
Mailing Address - Country:US
Mailing Address - Phone:505-867-5848
Mailing Address - Fax:
Practice Address - Street 1:4060 MONTREAL LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8420
Practice Address - Country:US
Practice Address - Phone:505-867-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist