Provider Demographics
NPI:1013234228
Name:BOEDEKER, ERIN JENSEN (LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JENSEN
Last Name:BOEDEKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 SPOKANE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2600
Mailing Address - Country:US
Mailing Address - Phone:406-260-5806
Mailing Address - Fax:
Practice Address - Street 1:244 SPOKANE AVE STE 7
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2600
Practice Address - Country:US
Practice Address - Phone:406-260-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist