Provider Demographics
NPI:1043393382
Name:BOYUM, JANICE MARY (MSLP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARY
Last Name:BOYUM
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SOUTH 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3857
Mailing Address - Country:US
Mailing Address - Phone:507-625-7660
Mailing Address - Fax:507-625-8998
Practice Address - Street 1:710 SOUTH 2ND ST.
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3857
Practice Address - Country:US
Practice Address - Phone:507-625-7660
Practice Address - Fax:507-625-8998
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3944103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist