MEDICARE: KRISTINA MARIE BOSWELL LMFT

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	106H00000X	Marriage & Family Therapist	118752	CA
2	106H00000X	Marriage & Family Therapist	IMF92920	CA

General Provider Information

NPI Number	:	1952849978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE BOSWELL LMFT

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	DIXON
State	:	CA
Zip	:	95620-0126
Country	:	US
Telephone Number	:	530-591-3071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 STONE BLVD STE 175
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4055
Country	:	US
Telephone Number	:	530-564-8360
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	08/09/2022

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