Provider Demographics
NPI:1184029357
Name:BORO-BOSWELL, DIANA CODY (MSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CODY
Last Name:BORO-BOSWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CODY
Other - Last Name:BORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-234-9591
Mailing Address - Fax:
Practice Address - Street 1:4455 NE HIGHWAY 20
Practice Address - Street 2:CHILDREN'S FARM HOME
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9695
Practice Address - Country:US
Practice Address - Phone:541-750-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor