Individual
DR. KELLI LYNN BOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2027 4TH ST, JACKSON, MI 49203-4572
(517) 888-5055
(517) 888-5052
Mailing address
2027 4TH ST, JACKSON, MI 49203-4572
(517) 817-6017
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000599
MI
231HA2400X
Assistive Technology Practitioner Audiologist
1601000599
MI
231HA2500X
Assistive Technology Supplier Audiologist
1601000599
MI
237600000X
Audiologist-Hearing Aid Fitter
1601000599
MI
Other
Enumeration date
09/27/2011
Last updated
05/02/2017
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