Individual
MS. THERESA ANN BOOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
4 PINE RIDGE CIR, CLANCY, MT 59634-9760
(406) 422-0411
Mailing address
4 PINE RIDGE CIR, CLANCY, MT 59634-9760
(406) 422-0411
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
246.000083
IL
170300000X
Genetic Counselor (M.S.)
GC0000000027
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002038
AMERICAN BOARD OF GENETIC COUNELING CERTIFICATION
MT
01
—
246.000083
LICENSED GENETIC COUNSELOR
IL
01
—
GC0000000027
LICENSED GENETIC COUNSELOR
TN
Enumeration date
10/19/2011
Last updated
10/19/2011
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