# DR. RENEE L. BOOMGAARDEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1215971056
- **Gender:** F
- **Credential:** PH.D

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 265 | ND | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 02/03/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 14293 | BC/BS | ND |
| 05 | — | 54523 | — | ND |
| 01 | — | 680008169 | RR MEDICARE | — |