Provider Demographics
NPI:1891100079
Name:BOESEM, NORA CHRISTINA (MSW, CSW, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:CHRISTINA
Last Name:BOESEM
Suffix:
Gender:F
Credentials:MSW, CSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 KANSAS CITY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3798
Mailing Address - Country:US
Mailing Address - Phone:605-348-6086
Mailing Address - Fax:605-348-1050
Practice Address - Street 1:529 KANSAS CITY ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3798
Practice Address - Country:US
Practice Address - Phone:605-348-6086
Practice Address - Fax:605-348-1050
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SD48861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor