Provider Demographics
NPI:1184764631
Name:SHECK-BOEHLER, CLAREN E (PHD)
Entity type:Individual
Prefix:DR
First Name:CLAREN
Middle Name:E
Last Name:SHECK-BOEHLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 KIESWETTER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8674
Mailing Address - Country:US
Mailing Address - Phone:419-866-0138
Mailing Address - Fax:419-866-0138
Practice Address - Street 1:3150 N REPUBLIC BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1514
Practice Address - Country:US
Practice Address - Phone:419-214-9320
Practice Address - Fax:419-214-9320
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2031054Medicaid
OHCP20383Medicare ID - Type Unspecified
OH2031054Medicaid