Provider Demographics
NPI:1336520451
Name:BOGGS, SANDRA MARIE (RT (R)(CT))
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RT (R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S FROELICH LN
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:IL
Mailing Address - Zip Code:61410-1620
Mailing Address - Country:US
Mailing Address - Phone:309-299-9138
Mailing Address - Fax:
Practice Address - Street 1:200 S FROELICH LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:IL
Practice Address - Zip Code:61410-1620
Practice Address - Country:US
Practice Address - Phone:309-299-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5004935912471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography