Provider Demographics
NPI:1598460586
Name:BOLL, IRENE (BA PSYCH)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BOLL
Suffix:
Gender:F
Credentials:BA PSYCH
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:WEISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3630 E 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3630 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3416
Practice Address - Country:US
Practice Address - Phone:907-770-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)