Provider Demographics
NPI:1851601322
Name:BOER, TARA LYNN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:BOER
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 1:315 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1801
Mailing Address - Country:US
Mailing Address - Phone:712-722-4900
Mailing Address - Fax:712-722-4901
Practice Address - Street 1:1419 1ST ST
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239-7341
Practice Address - Country:US
Practice Address - Phone:712-898-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health