Provider Demographics
NPI:1952458788
Name:BOGUS, JANET CAROL (F-AAA)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:CAROL
Last Name:BOGUS
Suffix:
Gender:F
Credentials:F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4067
Mailing Address - Country:US
Mailing Address - Phone:910-833-8145
Mailing Address - Fax:910-833-8146
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4067
Practice Address - Country:US
Practice Address - Phone:910-833-8145
Practice Address - Fax:910-833-8146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6994231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411788Medicaid
NC2520979AMedicare PIN