Provider Demographics
NPI:1225448905
Name:BOEHM, VERONICA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:BOEHM
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-1318
Mailing Address - Country:US
Mailing Address - Phone:361-389-4054
Mailing Address - Fax:
Practice Address - Street 1:13600 E STATE HIGHWAY 107
Practice Address - Street 2:STE. 6
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1644
Practice Address - Country:US
Practice Address - Phone:956-386-9008
Practice Address - Fax:956-287-4570
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist