Provider Demographics
NPI:1609027861
Name:BOEHMER, CHRISTINA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BOEHMER
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 1:6500 KILIMANJARO DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5300
Mailing Address - Country:US
Mailing Address - Phone:740-503-7431
Mailing Address - Fax:
Practice Address - Street 1:6500 KILIMANJARO DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5300
Practice Address - Country:US
Practice Address - Phone:740-503-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSLP.0000723OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES: DIVISION OF PROFESSIONS AND OCCUPATI
12137189OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION