Provider Demographics
NPI:1821222779
Name:BOETTCHER, JULIE THERESE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:THERESE
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-4049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 EVERGREEN CIR
Practice Address - Street 2:
Practice Address - City:GILBERTS
Practice Address - State:IL
Practice Address - Zip Code:60136-4049
Practice Address - Country:US
Practice Address - Phone:847-975-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist