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Individual

MR. JEREMY PATRICK BOAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2024023364
MO
1041C0700X
Clinical Social Worker
Primary
L15438
OR

Other

Enumeration date
07/20/2022
Last updated
08/12/2024
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