Provider Demographics
NPI:1912191909
Name:BOELTER, SHELLY E (AUD CCC-A)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:E
Last Name:BOELTER
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 SW BOND AVE
Mailing Address - Street 2:SUITE 173
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4507
Mailing Address - Country:US
Mailing Address - Phone:503-688-6590
Mailing Address - Fax:503-688-6595
Practice Address - Street 1:3550 SW BOND AVE
Practice Address - Street 2:SUITE 173
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4507
Practice Address - Country:US
Practice Address - Phone:503-688-6590
Practice Address - Fax:503-688-6595
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22552231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist