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Individual

TIFFANY FAWN BOGGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14715 E. HWY 20, 14725 CATHOLIC CHURCH RD., CLEARLAKE OAKS, CA 95423-9542
(707) 998-1800
(707) 998-0122
Mailing address
PO BOX 316, LUCERNE, CA 95458-0316
(707) 998-1800

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
MPSS-QASLME
CA
172V00000X
Community Health Worker
CA
175T00000X
Peer Specialist
MPSS-QASLME
CA
175T00000X
Peer Specialist
Primary
CA

Other

Enumeration date
11/13/2024
Last updated
03/24/2026
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