Provider Demographics
NPI:1396290334
Name:BOAHENG, EVE R (HIS)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:R
Last Name:BOAHENG
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:18315 CASCADE DR
Practice Address - Street 2:100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347
Practice Address - Country:US
Practice Address - Phone:952-294-4327
Practice Address - Fax:952-294-1027
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2773237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter