Provider Demographics
NPI:1831440353
Name:BOLAND, AMY M (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:BOLAND
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 FISHINGER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7505
Mailing Address - Country:US
Mailing Address - Phone:614-219-1510
Mailing Address - Fax:614-219-1511
Practice Address - Street 1:3535 FISHINGER BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7505
Practice Address - Country:US
Practice Address - Phone:614-219-1510
Practice Address - Fax:614-219-1511
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
OH6913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent