Provider Demographics
NPI:1891953899
Name:BOGGESS, WILLIAM JACK (MS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACK
Last Name:BOGGESS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 RENFERT WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5658
Mailing Address - Country:US
Mailing Address - Phone:512-601-0303
Mailing Address - Fax:512-601-0333
Practice Address - Street 1:12221 RENFERT WAY STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5658
Practice Address - Country:US
Practice Address - Phone:512-601-0303
Practice Address - Fax:512-601-0333
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50873231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist