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General NPI Number Information
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NPI Number | 1003597626
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Entity Type | Individual
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Provider Name | VICTORIA MICHEL BOESEN MA, BCABA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 17520 OLD JEFFERSON HWY
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3903
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Country | US
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Telephone | 225-300-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 14507 ESSEN TERRACE DR
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City | GONZALES
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State | LA
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Zip | 70737-7164
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Country | US
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Telephone | 985-233-1074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-23-14540
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License Number State | LA
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