Provider Demographics
NPI:1851738025
Name:BOGGS, TIANN RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIANN
Middle Name:RAE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TIANN
Other - Middle Name:RAE
Other - Last Name:POLONCIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12274 322ND AVE
Mailing Address - Street 2:
Mailing Address - City:JAVA
Mailing Address - State:SD
Mailing Address - Zip Code:57452
Mailing Address - Country:US
Mailing Address - Phone:605-850-1172
Mailing Address - Fax:
Practice Address - Street 1:614 S 1ST ST
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637-2131
Practice Address - Country:US
Practice Address - Phone:307-337-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist