Provider Demographics
NPI:1942485388
Name:BOATZ, DONNA SHERYL (AUD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:SHERYL
Last Name:BOATZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:SHERYL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4531 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4503
Mailing Address - Country:US
Mailing Address - Phone:812-234-3277
Mailing Address - Fax:812-234-3507
Practice Address - Street 1:4531 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4503
Practice Address - Country:US
Practice Address - Phone:812-234-3277
Practice Address - Fax:812-234-3507
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002188A231H00000X
IL147-000091231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888140Medicaid
IN200888140Medicaid