Provider Demographics
NPI:1619421658
Name:BOE, DAVID THOMAS
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:BOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W PIERCE RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-3116
Mailing Address - Country:US
Mailing Address - Phone:630-733-1985
Mailing Address - Fax:
Practice Address - Street 1:333 W PIERCE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-3116
Practice Address - Country:US
Practice Address - Phone:630-733-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker