Provider Demographics
NPI:1720594435
Name:BOETSCHER, HOLLIE (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:BOETSCHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14723 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2949
Mailing Address - Country:US
Mailing Address - Phone:815-436-6128
Mailing Address - Fax:
Practice Address - Street 1:14723 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2949
Practice Address - Country:US
Practice Address - Phone:815-436-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist