Provider Demographics
NPI:1992102933
Name:BOGGS, MELISSA (MA CCC/SLP-L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MA CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 STATE ROUTE 335
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8950
Mailing Address - Country:US
Mailing Address - Phone:740-776-6019
Mailing Address - Fax:
Practice Address - Street 1:3768 STATE ROUTE 335
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8950
Practice Address - Country:US
Practice Address - Phone:740-776-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist