Healthcare Provider Details

I. General information

NPI: 1992102982
Provider Name (Legal Business Name): ANDREA CURRENT-BOMER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 BRIM RD STE 3
BOWLING GREEN OH
43402-9800
US

IV. Provider business mailing address

1302 BRIM RD STE 3
BOWLING GREEN OH
43402-9800
US

V. Phone/Fax

Practice location:
  • Phone: 419-292-5382
  • Fax: 419-292-5384
Mailing address:
  • Phone: 419-292-5382
  • Fax: 419-292-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6966
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20042589A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: