Individual
KIRSTEN LARA BOGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
1119 HIGH STREET, BRADFORD, PA 16701
(716) 307-2557
Mailing address
1119 HIGH STREET, BRADFORD, PA 16701
(716) 307-2557
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
012242-1
NY
235Z00000X
Speech-Language Pathologist
0122421
NY
235Z00000X
Speech-Language Pathologist
SL009962
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02341564
—
NY
Enumeration date
12/02/2008
Last updated
10/19/2022
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