Raymond Boetger, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

30365 Issued in CA

Practice address

8593 San Antonio Dr
Buena Park, CA 90620-3705

Phone

(714) 485-8822

NPI assigned

Jan 16, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Expressable Speech-Language Pathology, P.C.

  • Speech-Language Pathologist
  • Austin, TX
  • NPI 1649875857

  CA

  Medicare reassignment NPD
• Coastline Speech Therapy, Inc.

  • Speech-Language Pathologist
  • Buena Park, CA
  • NPI 1710677026
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1609312594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8593 SAN ANTONIO DR",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906203705",
            "telephone_number": "360-536-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8593 SAN ANTONIO DR",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906203705",
            "telephone_number": "714-485-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETGER",
        "first_name": "RAYMOND",
        "name_prefix": "Mr.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-16",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "30365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.