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Individual
BRIAN L BOOMGARDEN
Active
Individual
BRIAN L BOOMGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS CADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11165
WI
101YM0800X
Mental Health Counselor
Primary
2898-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13647
NETWORK HEALTH PLAN
—
01
—
390806395
CIGNA
—
05
—
39647200
—
WI
Enumeration date
07/16/2006
Last updated
06/03/2008
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