Healthcare Provider Details

I. General information

NPI: 1972578102
Provider Name (Legal Business Name): EVONNE LEE VONBOECK SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 1005 BOX 50
FPO AE
09593
US

IV. Provider business mailing address

PSC 1005 BOX 50
FPO AE
09593
US

V. Phone/Fax

Practice location:
  • Phone: 01153997353
  • Fax:
Mailing address:
  • Phone: 01153997353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: