Provider Demographics
NPI:1972578102
Name:VONBOECK, EVONNE LEE (SLP)
Entity Type:Individual
Prefix:
First Name:EVONNE
Middle Name:LEE
Last Name:VONBOECK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 1005
Mailing Address - Street 2:BOX 50
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09593
Mailing Address - Country:US
Mailing Address - Phone:0115-399-7353
Mailing Address - Fax:
Practice Address - Street 1:PSC 1005
Practice Address - Street 2:BOX 50
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09593
Practice Address - Country:US
Practice Address - Phone:0115-399-7353
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist