Provider Demographics
NPI:1548563968
Name:SMITH-BOGERT, PENNY JOAN (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:JOAN
Last Name:SMITH-BOGERT
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9747
Mailing Address - Country:US
Mailing Address - Phone:518-869-0293
Mailing Address - Fax:518-464-6458
Practice Address - Street 1:2225 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9747
Practice Address - Country:US
Practice Address - Phone:518-869-0293
Practice Address - Fax:518-464-6458
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist