Provider Demographics
NPI:1770882201
Name:BOGGS, HEIDI (MACCC-S)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MACCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PRIVATE DRIVE 155
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-7877
Mailing Address - Country:US
Mailing Address - Phone:304-633-1833
Mailing Address - Fax:304-633-1833
Practice Address - Street 1:21 PRIVATE DRIVE 155
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7877
Practice Address - Country:US
Practice Address - Phone:304-633-1833
Practice Address - Fax:304-633-1833
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 5894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist