MEDICARE: DR. COREEN BOEDING HOCKENBERRY BOEDING PH.D.

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	103TC0700X	Clinical Psychologist	595	CO

General Provider Information

NPI Number	:	1639238280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREEN BOEDING HOCKENBERRY BOEDING PH.D.

Provider Business Mailing Address
First Line	:	2550 STOVER ST UNIT E101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4643
Country	:	US
Telephone Number	:	970-493-3440
Fax Number	:	970-221-2643

Provider Business Practice Location Address
First Line	:	2550 STOVER ST UNIT E101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4643
Country	:	US
Telephone Number	:	970-493-3440
Fax Number	:	970-221-2643

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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