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General NPI Number Information
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NPI Number | 1457589467
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Entity Type | Individual
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Provider Name | IRVING BOONE PH.D
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Gender | Male
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 1010 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4746
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Country | US
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Telephone | 651-659-0359
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Fax | 651-645-1688
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Provider Business Mailing Address
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Address Line | 1044 LAWSON AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-3328
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Country | US
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Telephone | 651-216-5774
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Fax | 651-645-1688
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 300575
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License Number State | MN
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