Provider Demographics
NPI:1124486907
Name:BOGGS, JOSIE (LSWA-IC)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LSWA-IC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11802 W JENILYN CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1794
Mailing Address - Country:US
Mailing Address - Phone:801-633-5918
Mailing Address - Fax:
Practice Address - Street 1:2273 S VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-7341
Practice Address - Country:US
Practice Address - Phone:208-343-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC603313691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical