Provider Demographics
NPI:1447591300
Name:BOGGS, DANIELLE (LMP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 NE 15TH AVE
Mailing Address - Street 2:APT # D366
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 BROADWAY ST
Practice Address - Street 2:SUITE 650
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3276
Practice Address - Country:US
Practice Address - Phone:360-690-0081
Practice Address - Fax:360-690-0083
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60188555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist