Basic Information
| Provider Information | |||||||||
| NPI: | 1568004885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGGS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JANICE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3629 S D ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984186813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537984618 | ||||||||
| FaxNumber: | 2537982935 | ||||||||
| Practice Location | |||||||||
| Address1: | 3629 S D ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984186813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537984618 | ||||||||
| FaxNumber: | 2537982935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP60905974 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.