Healthcare Provider Details

I. General information

NPI: 1972508844
Provider Name (Legal Business Name): ANTHONY L BOER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: TONY L BOER MSWW

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S SYCAMORE AVE STE 101
SIOUX FALLS SD
57110-4263
US

IV. Provider business mailing address

2000 S SYCAMORE AVE STE 101
SIOUX FALLS SD
57110-4263
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-0261
  • Fax: 605-271-0263
Mailing address:
  • Phone: 605-271-0261
  • Fax: 605-271-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1865
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: