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General NPI Number Information
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NPI Number | 1164510954
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Entity Type | Individual
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Provider Name | SANDRA D BOUMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 414 W MORELAND BLVD SUITE #205 FAMILY SERVICE OF WAUKESHA
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City | WAUKESHA
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State | WI
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Zip | 53188
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Country | US
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Telephone | 262-547-5567
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Fax | 262-547-1608
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Provider Business Mailing Address
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Address Line | 414 W MORELAND BLVD SUITE #205 FAMILY SERVICE OF WAUKESHA
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City | WAUKESHA
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State | WI
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Zip | 53188
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Country | US
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Telephone | 262-547-5567
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Fax | 262-547-1608
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1962123
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License Number State | WI
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