Provider Demographics
NPI:1033237623
Name:BOGEN WHITEMAN, ELIZABETH ANNE (SLP)
Entity type:Individual
Prefix:MR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BOGEN WHITEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:BOGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:18828 PR 1239 NW
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350
Mailing Address - Country:US
Mailing Address - Phone:509-832-2384
Mailing Address - Fax:
Practice Address - Street 1:1109 MEADE AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1366
Practice Address - Country:US
Practice Address - Phone:509-786-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist