Individual
DONIQUE BOAZEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3140 JUANIPERO WAY STE 101, MEDFORD, OR 97504-8647
(541) 323-4800
Mailing address
225 MAIN ST UNIT 202, HIRAM, GA 30141-6101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/20/2025
Last updated
06/20/2025
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