Provider Demographics
NPI:1952427544
Name:BOOM, WILLIAM S
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:BOOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 UNIVERSITY DR STE 140
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2783
Mailing Address - Country:US
Mailing Address - Phone:677-289-6579
Mailing Address - Fax:
Practice Address - Street 1:3252 UNIVERSITY DR STE 140
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2783
Practice Address - Country:US
Practice Address - Phone:667-289-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680D410100OtherBCBS OF MI