Provider Demographics
NPI:1831910397
Name:AMY M BOLAND PHD NCSP LLC
Entity type:Organization
Organization Name:AMY M BOLAND PHD NCSP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-984-1981
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities