Provider Demographics
NPI:1740468446
Name:BOGARD FAMILY THERAPY & REHAB
Entity type:Organization
Organization Name:BOGARD FAMILY THERAPY & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN SPICELAND
Authorized Official - Last Name:BOGARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:931-232-5200
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-0682
Mailing Address - Country:US
Mailing Address - Phone:931-232-5200
Mailing Address - Fax:931-232-1120
Practice Address - Street 1:949 HWY 79
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-0949
Practice Address - Country:US
Practice Address - Phone:931-232-5200
Practice Address - Fax:931-232-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty