Basic Information
| Provider Information | |||||||||
| NPI: | 1437408507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGGS | ||||||||
| FirstName: | JERONE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 OLIVE ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631032377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142063863 | ||||||||
| FaxNumber: | 3142063708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 OLIVE ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631032377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142063863 | ||||||||
| FaxNumber: | 3142063708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.