Provider Demographics
NPI:1720577836
Name:CHRISTINA BOEHMER, SPEECH-LANGUAGE PATHOLOGY LLC
Entity Type:Organization
Organization Name:CHRISTINA BOEHMER, SPEECH-LANGUAGE PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-503-7431
Mailing Address - Street 1:6500 KILIMANJARO DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5300
Mailing Address - Country:US
Mailing Address - Phone:740-503-7431
Mailing Address - Fax:
Practice Address - Street 1:6500 KILIMANJARO DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5300
Practice Address - Country:US
Practice Address - Phone:740-503-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty