Provider Demographics
NPI:1720253966
Name:BOGGAN, DEBORAH D (MS CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:D
Last Name:BOGGAN
Suffix:
Gender:F
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 MULEY RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-9122
Mailing Address - Country:US
Mailing Address - Phone:601-635-2825
Mailing Address - Fax:
Practice Address - Street 1:15305 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327-7208
Practice Address - Country:US
Practice Address - Phone:601-635-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist