Individual
DR. JEFFREY THEODORE BOSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
821 RAYMOND AVE, SUITE 150, SAINT PAUL, MN 55114-1503
(651) 642-9741
Mailing address
1821 UNIVERSITY AVE W, STE 155, SAINT PAUL, MN 55104-2880
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3768
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184314100
—
MN
01
—
245L9BO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/19/2007
Last updated
02/26/2021
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