Provider Demographics
NPI:1912297409
Name:BOESE, ROSHAN ELIZABETH (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:ELIZABETH
Last Name:BOESE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:ROSHAN
Other - Middle Name:ELIZABETH
Other - Last Name:BOESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:492 GRAY HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8943
Mailing Address - Country:US
Mailing Address - Phone:605-759-2843
Mailing Address - Fax:
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-540-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1451235Z00000X
COSLP.0001917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist