Provider Demographics
NPI:1700123163
Name:BOGGS, ALLISON CAROL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CAROL
Last Name:BOGGS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:BOGGS
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:536 GRAND SLAM DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8044
Mailing Address - Country:US
Mailing Address - Phone:706-854-8434
Mailing Address - Fax:706-854-8435
Practice Address - Street 1:536 GRAND SLAM DR
Practice Address - Street 2:SUITE D
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8044
Practice Address - Country:US
Practice Address - Phone:706-854-8434
Practice Address - Fax:706-854-8435
Is Sole Proprietor?:No
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist