MEDICARE: COURTNEY BOLAND

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	103K00000X	Behavior Analyst
2	174400000X	Specialist

General Provider Information

NPI Number	:	1881233179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BOLAND

Provider Business Mailing Address
First Line	:	14835 XKIMO ST NW
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-6189
Country	:	US
Telephone Number	:	636-140-4467
Fax Number	:

Provider Business Practice Location Address
First Line	:	5939 RICE CREEK PKWY
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5021
Country	:	US
Telephone Number	:	612-888-9889
Fax Number	:

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

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	01/15/2026

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Directions to “ COURTNEY BOLAND ” Practice Location

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