Provider Demographics
NPI:1306230057
Name:BOEH, HENRY (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:BOEH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N. SUNNYSLOPE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3574
Mailing Address - Country:US
Mailing Address - Phone:262-782-2820
Mailing Address - Fax:
Practice Address - Street 1:250 N. SUNNYSLOPE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-3574
Practice Address - Country:US
Practice Address - Phone:262-782-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist