Provider Demographics
NPI:1326579061
Name:BOGSETH, AMY (BS, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BOGSETH
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 MORAINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-5006
Mailing Address - Country:US
Mailing Address - Phone:847-345-2195
Mailing Address - Fax:
Practice Address - Street 1:2744 MORAINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-5006
Practice Address - Country:US
Practice Address - Phone:847-345-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41582174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN