Provider Demographics
NPI:1912656109
Name:BOGUNIA, ALYSSA (RBT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BOGUNIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56664 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-1775
Mailing Address - Country:US
Mailing Address - Phone:269-845-6447
Mailing Address - Fax:
Practice Address - Street 1:2014 LINCOLNWAY E STE 3
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6818
Practice Address - Country:US
Practice Address - Phone:239-920-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician