Healthcare Provider Details

I. General information

NPI: 1942150461
Provider Name (Legal Business Name): NEUROFIRM MENTAL HEALTH AND MEMORY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12175 HEFFNER RD
KINGSTON OH
45644-9661
US

IV. Provider business mailing address

12175 HEFFNER RD
KINGSTON OH
45644-9661
US

V. Phone/Fax

Practice location:
  • Phone: 740-572-3088
  • Fax:
Mailing address:
  • Phone: 740-572-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BOEDEKER
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: AHNP
Phone: 740-572-3088