Provider Demographics
NPI:1639400500
Name:BOGERT, TAMA ROSE (AAS-HIS #4369)
Entity Type:Individual
Prefix:MS
First Name:TAMA
Middle Name:ROSE
Last Name:BOGERT
Suffix:
Gender:F
Credentials:AAS-HIS #4369
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 W PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1861
Mailing Address - Country:US
Mailing Address - Phone:509-327-5045
Mailing Address - Fax:
Practice Address - Street 1:9502 N NEWPORT HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1147
Practice Address - Country:US
Practice Address - Phone:509-465-2243
Practice Address - Fax:509-465-2269
Is Sole Proprietor?:No
Enumeration Date:2010-01-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4369OtherHEARING INSTRUMENT FITTER