Provider Demographics
NPI:1750508891
Name:BOE, WANDA JEANETTE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JEANETTE
Last Name:BOE
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:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-1387
Mailing Address - Country:US
Mailing Address - Phone:425-985-2396
Mailing Address - Fax:425-888-0372
Practice Address - Street 1:1420 NW GILMAN BLVD # 2118
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5394
Practice Address - Country:US
Practice Address - Phone:425-985-2396
Practice Address - Fax:425-888-0372
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist