Healthcare Provider Details

I. General information

NPI: 1669712543
Provider Name (Legal Business Name): SARA BOILEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 2ND ST W
WHITEFISH MT
59937-3006
US

IV. Provider business mailing address

188 MOONRIDGE DR
WHITEFISH MT
59937-8792
US

V. Phone/Fax

Practice location:
  • Phone: 406-662-1771
  • Fax:
Mailing address:
  • Phone: 406-662-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1196
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1196
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: