Provider Demographics
NPI:1376558288
Name:BOEDECKER, ANNE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:L
Last Name:BOEDECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3612
Mailing Address - Country:US
Mailing Address - Phone:603-226-2230
Mailing Address - Fax:603-224-0278
Practice Address - Street 1:4 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-3612
Practice Address - Country:US
Practice Address - Phone:603-226-2230
Practice Address - Fax:603-224-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80008498Medicaid
NH80008498Medicaid