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Individual

JIM BOGGS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
123 S WEBB RD, GRAND ISLAND, NE 68803-5110
(308) 385-5900
Mailing address
123 S WEBB RD, GRAND ISLAND, NE 68803-5110
(308) 385-5900

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
235200000X
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
235200000X
NE
Enumeration date
10/26/2016
Last updated
10/26/2016
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