Individual
TIFFANY BOYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
365 NE COURT ST, PRINEVILLE, OR 97754-1936
(541) 323-5330
(541) 447-6694
Mailing address
365 NE COURT ST, PRINEVILLE, OR 97754-1936
(541) 323-5330
(541) 447-6694
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283234
—
OR
Enumeration date
06/05/2014
Last updated
06/05/2014
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