Healthcare Provider Details

I. General information

NPI: 1811746548
Provider Name (Legal Business Name): AMY M BOYD-BOLME LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY M BOYD

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W ROSSER AVE
BISMARCK ND
58501-3755
US

IV. Provider business mailing address

217 W ROSSER AVE
BISMARCK ND
58501-3755
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-6909
  • Fax: 701-255-3922
Mailing address:
  • Phone: 701-255-6909
  • Fax: 701-255-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4393
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: