Individual
DR. RENEE L. BOOMGAARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
1463 I94 BUSINESS LOOP E, DICKINSON, ND 58601-6434
(701) 227-7500
(701) 227-7575
Mailing address
1463 I94 BUSINESS LOOP E, DICKINSON, ND 58601-6434
(701) 227-7500
(701) 227-7575
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
265
ND
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14293
BC/BS
ND
05
—
54523
—
ND
01
—
680008169
RR MEDICARE
—
Enumeration date
06/15/2006
Last updated
02/03/2022
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