Provider Demographics
NPI:1275851560
Name:BOES, KORI ELIZABETH (LSAC)
Entity Type:Individual
Prefix:MS
First Name:KORI
Middle Name:ELIZABETH
Last Name:BOES
Suffix:
Gender:F
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E 200 S
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2110
Mailing Address - Country:US
Mailing Address - Phone:801-363-0203
Mailing Address - Fax:801-359-3455
Practice Address - Street 1:607 E 200 S
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-2110
Practice Address - Country:US
Practice Address - Phone:801-363-0203
Practice Address - Fax:801-359-3455
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6634493-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)