MEDICARE: MARY BOEHM M.A., CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	1913	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629146220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BOEHM M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 SAN VICTORIO AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-5947
Country	:	US
Telephone Number	:	505-293-4259
Fax Number	:	505-293-4586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/13/2025

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