Healthcare Provider Details

I. General information

NPI: 1235975236
Provider Name (Legal Business Name): ASHLEY BOEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 EKHART ST NE
GRAND RAPIDS MI
49503-1380
US

IV. Provider business mailing address

183 SUDAN DR SE
LOWELL MI
49331-8644
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-3492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: