Provider Demographics
NPI:1669093605
Name:BOGGS, IVY MARIE (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:MARIE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:MARIE
Other - Last Name:BOGGIS GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:11 HODGKINS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03868-5911
Mailing Address - Country:US
Mailing Address - Phone:603-335-6286
Mailing Address - Fax:
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-3099
Practice Address - Country:US
Practice Address - Phone:603-692-4411
Practice Address - Fax:603-692-6717
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist