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General NPI Number Information
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NPI Number | 1821986027
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Entity Type | Individual
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Provider Name | BEBE ESPRIT BOYLAN PSS
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 140 S HOLLY ST
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City | MEDFORD
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State | OR
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Zip | 97501-3113
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Country | US
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Telephone | 971-235-6152
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Fax |
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Provider Business Mailing Address
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Address Line | 760 NORMAL AVE
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City | ASHLAND
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State | OR
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Zip | 97520-2421
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Country | US
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Telephone | 971-235-6152
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 114147
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License Number State | OR
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