Provider Demographics
NPI:1891234522
Name:BOEHMLEHNER, WYLIE (BA, LADC)
Entity Type:Individual
Prefix:
First Name:WYLIE
Middle Name:
Last Name:BOEHMLEHNER
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 E RIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-4525
Mailing Address - Country:US
Mailing Address - Phone:320-593-0440
Mailing Address - Fax:320-593-0442
Practice Address - Street 1:1326 E RIPLEY ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-4525
Practice Address - Country:US
Practice Address - Phone:320-593-0440
Practice Address - Fax:320-593-0442
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303968101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)