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NPI Code Detail

MEDICARE: GRACE ELIZABETH LOUISE BOEHNKE LADC

MEDICARE: GRACE ELIZABETH LOUISE BOEHNKE LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor304271MN

General Provider Information

NPI Number : 1063089134
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ELIZABETH LOUISE BOEHNKE LADC
Provider Business Mailing Address
First Line : 126 8TH ST NE
Second Line :
City : BYRON
State : MN
Zip : 55920-1440
Country : US
Telephone Number : 651-829-0191
Fax Number :
Provider Business Practice Location Address
First Line : 604 5TH ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-3256
Country : US
Telephone Number : 507-282-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2021
Last Update Date : 06/08/2021

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Directions to “ GRACE ELIZABETH LOUISE BOEHNKE LADC” Practice Location

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