Individual
ERICA MARIE BOAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
614 SOUTH AVE, SPRINGFIELD, MO 65806-3110
(417) 869-9011
Mailing address
614 SOUTH AVE, SPRINGFIELD, MO 65806-3110
(417) 869-9011
(417) 889-6307
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2015026778
MO
Other
Enumeration date
06/01/2016
Last updated
01/28/2019
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