Provider Demographics
NPI:1396946992
Name:BOGER, BUFFY RENEE (MS SLP CCC)
Entity type:Individual
Prefix:
First Name:BUFFY
Middle Name:RENEE
Last Name:BOGER
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 LONDON ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-6225
Mailing Address - Country:US
Mailing Address - Phone:940-553-3784
Mailing Address - Fax:
Practice Address - Street 1:1711 LONDON ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-6225
Practice Address - Country:US
Practice Address - Phone:940-553-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist