Provider Demographics
NPI:1306192844
Name:BOISEN, ASHLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BOISEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 UNIVERSITY AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1510
Mailing Address - Country:US
Mailing Address - Phone:515-254-1556
Mailing Address - Fax:515-254-1559
Practice Address - Street 1:6900 UNIVERSITY AVE STE 115
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1510
Practice Address - Country:US
Practice Address - Phone:515-254-1556
Practice Address - Fax:515-254-1559
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health