Provider Demographics
NPI:1891848354
Name:BOYER, BRIAN (MSW, LISW, ACSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BOYER
Suffix:
Gender:M
Credentials:MSW, LISW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 NE CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4577
Mailing Address - Country:US
Mailing Address - Phone:515-965-0189
Mailing Address - Fax:515-965-0189
Practice Address - Street 1:1509 NE CORNERSTONE CT
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4577
Practice Address - Country:US
Practice Address - Phone:515-965-0189
Practice Address - Fax:515-965-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA010741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical