Healthcare Provider Details

I. General information

NPI: 1760253108
Provider Name (Legal Business Name): KATHLEEN ELIZABETH BOASE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 SW MADISON AVE STE 207
CORVALLIS OR
97333-4757
US

IV. Provider business mailing address

257 SW MADISON AVE STE 207
CORVALLIS OR
97333-4757
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-8350
  • Fax:
Mailing address:
  • Phone: 541-224-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8724
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: