Individual
BRIAN L BOOMGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS CADC
Contact information
Practice address
339 REED AVE, MANITOWOC, WI 54220-2020
(920) 320-8600
(920) 320-8662
Mailing address
PO BOX 2290, MANITOWOC, WI 54221-2290
(920) 320-8600
(920) 320-8662
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11165
WI
101YM0800X
Mental Health Counselor
Primary
2898-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13647
NETWORK HEALTH PLAN
—
01
—
390806395
CIGNA
—
05
—
39647200
—
WI
Enumeration date
07/16/2006
Last updated
06/03/2008
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