Provider Demographics
NPI:1669685954
Name:BOGETTO-WEINRAUB, AMY ANN (MM,MT-BC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ANN
Last Name:BOGETTO-WEINRAUB
Suffix:
Gender:F
Credentials:MM,MT-BC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:BOGETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MM,MT-BC
Mailing Address - Street 1:7355 NORENE CT
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8116
Mailing Address - Country:US
Mailing Address - Phone:734-645-7314
Mailing Address - Fax:
Practice Address - Street 1:7355 NORENE CT
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-8116
Practice Address - Country:US
Practice Address - Phone:734-645-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI04874225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist