Provider Demographics
NPI:1326580291
Name:BOEHMLER, EMILY SUZANNE (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUZANNE
Last Name:BOEHMLER
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-454-9759
Practice Address - Street 1:703 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5021
Practice Address - Country:US
Practice Address - Phone:513-831-2578
Practice Address - Fax:765-454-9759
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-16-22155103K00000X
OHCOBA.326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-22155OtherBCBA CERTIFICATE