Healthcare Provider Details

I. General information

NPI: 1508786013
Provider Name (Legal Business Name): AVERY PAIGE BOOGREN M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8599 N 32ND ST STE 104
RICHLAND MI
49083-8570
US

IV. Provider business mailing address

8599 N 32ND ST STE 104
RICHLAND MI
49083-8570
US

V. Phone/Fax

Practice location:
  • Phone: 810-931-2598
  • Fax: 269-359-3710
Mailing address:
  • Phone: 810-931-2598
  • Fax: 269-359-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: