Individual provider Active NPI

Nicole Bogner

  • Speech-Language Pathologist
  • Fort Wayne, IN
National Provider Identifier
1730814435
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
22007951A Issued in IN
Practice address
4935 Hillegas Rd Ste 200
Fort Wayne, IN 46818-1943
Phone
(260) 338-1241
NPI assigned
Jul 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 22007951A IN Primary

Addresses

Primary practice location

4935 Hillegas Rd Ste 200
Fort Wayne, IN 46818-1943

Mailing address

4935 Hillegas Rd Ste 200
Fort Wayne, IN 46818-1943
Phone (260) 338-1241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
22007951AINMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Possibilities Northeast, LLC. Speech-Language Pathologist PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1730814435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4935 HILLEGAS RD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181943",
            "telephone_number": "260-338-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4935 HILLEGAS RD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181943",
            "telephone_number": "260-338-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGNER",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22007951A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.