MEDICARE: MISS ANITA MARIE BOOS LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	303987	MN

General Provider Information

NPI Number	:	1497226799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANITA MARIE BOOS LADC

Provider Business Mailing Address
First Line	:	2515 N FERRY ST
Second Line	:
City	:	ANOKA
State	:	MN
Zip	:	55303-1654
Country	:	US
Telephone Number	:	763-310-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 FREMONT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1390
Country	:	US
Telephone Number	:	888-648-8349
Fax Number	:	651-348-8349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	12/16/2020

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