Provider Demographics
NPI:1639956998
Name:BOSKOFSKY, ANDREA LYNN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:BOSKOFSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:OUZINKIE
Mailing Address - State:AK
Mailing Address - Zip Code:99644-0149
Mailing Address - Country:US
Mailing Address - Phone:907-486-1390
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN ST.
Practice Address - Street 2:
Practice Address - City:OUZINKIE
Practice Address - State:AK
Practice Address - Zip Code:99644
Practice Address - Country:US
Practice Address - Phone:907-486-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)