Provider Demographics
NPI:1336374644
Name:BOECKELER, HEATHER MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:BOECKELER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SHOREHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5029
Mailing Address - Country:US
Mailing Address - Phone:516-434-1437
Mailing Address - Fax:
Practice Address - Street 1:122 SHOREHAM WAY
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5029
Practice Address - Country:US
Practice Address - Phone:516-434-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017484-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist