Provider Demographics
NPI:1770735961
Name:BOGARD, DENA M (SLP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:M
Last Name:BOGARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4806 TIMBER COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7161
Mailing Address - Country:US
Mailing Address - Phone:419-621-1166
Mailing Address - Fax:419-627-4263
Practice Address - Street 1:4806 TIMBER COMMONS DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7161
Practice Address - Country:US
Practice Address - Phone:419-621-1166
Practice Address - Fax:419-627-4263
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist