Provider Demographics
NPI:1841497062
Name:BOOHER, KENNETH (MS, F-AAA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BOOHER
Suffix:
Gender:M
Credentials:MS, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 MEDICAL CT E
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4623
Mailing Address - Country:US
Mailing Address - Phone:352-726-3131
Mailing Address - Fax:888-491-4391
Practice Address - Street 1:821 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4623
Practice Address - Country:US
Practice Address - Phone:352-726-3131
Practice Address - Fax:888-491-4367
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY193231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1337ZMedicare ID - Type Unspecified