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Individual
LAURA LYNN BOBERG
Active
Individual
LAURA LYNN BOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6855070-6006
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14997547
CAQH
—
Enumeration date
11/25/2020
Last updated
11/25/2020
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