Provider Demographics
NPI:1134880115
Name:BOGGS, TAMARA RAE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:RAE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PEQUIGNOT DR
Mailing Address - Street 2:
Mailing Address - City:PIERCETON
Mailing Address - State:IN
Mailing Address - Zip Code:46562-9081
Mailing Address - Country:US
Mailing Address - Phone:574-400-2186
Mailing Address - Fax:
Practice Address - Street 1:27 PEQUIGNOT DR
Practice Address - Street 2:
Practice Address - City:PIERCETON
Practice Address - State:IN
Practice Address - Zip Code:46562-9081
Practice Address - Country:US
Practice Address - Phone:574-400-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor