Provider Demographics
NPI:1275278707
Name:BOEH, SHANI DEON (AAS)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:DEON
Last Name:BOEH
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 W HAPPY VALLEY RD STE A104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2609
Mailing Address - Country:US
Mailing Address - Phone:623-224-1214
Mailing Address - Fax:
Practice Address - Street 1:6635 W HAPPY VALLEY RD STE A104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2609
Practice Address - Country:US
Practice Address - Phone:623-224-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA137272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty