Provider Demographics
NPI:1922288638
Name:BOYER, REGINA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:S
Last Name:BOYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 N LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-2443
Mailing Address - Country:US
Mailing Address - Phone:208-914-1009
Mailing Address - Fax:
Practice Address - Street 1:3012 S 44TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3408
Practice Address - Country:US
Practice Address - Phone:812-598-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-286141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical