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NPI Code Detail

MEDICARE: AMY BOLEN

MEDICARE: AMY BOLEN
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.171132OH

General Provider Information

NPI Number : 1619503257
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY BOLEN
Provider Business Mailing Address
First Line : 2216 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-1828
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2216 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-1828
Country : US
Telephone Number : 513-684-7965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2020
Last Update Date : 03/16/2020

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Directions to “ AMY BOLEN ” Practice Location

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