Provider Demographics
NPI:1013111350
Name:BOGGS, AMY L (LISW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2965
Mailing Address - Country:US
Mailing Address - Phone:419-382-2124
Mailing Address - Fax:
Practice Address - Street 1:5151 MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2184
Practice Address - Country:US
Practice Address - Phone:419-882-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00091611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00440789Medicare PIN
OHSW28922Medicare PIN
OHP00469759Medicare PIN