Provider Demographics
NPI:1598812158
Name:BOGGS, TERESA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-439-4584
Mailing Address - Fax:423-439-4607
Practice Address - Street 1:156 S DOSSETT DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-1702
Practice Address - Country:US
Practice Address - Phone:423-439-4355
Practice Address - Fax:423-439-4607
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSP1220OtherTENNESSEE LICENSE
TN1510971Medicaid