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General NPI Number Information
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NPI Number | 1316618226
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Entity Type | Individual
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Provider Name | BRENDA BOESE LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 44 STURGIS CORNER DR STE 9
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City | IOWA CITY
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State | IA
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Zip | 52246-5617
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Country | US
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Telephone | 319-481-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 BLAZING STAR DR
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City | IOWA CITY
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State | IA
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Zip | 52240-6849
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Country | US
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Telephone | 319-541-6705
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091361
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License Number State | IA
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