Laura Lynn Boberg, SUDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6855070-6006 Issued in UT

Practice address

222 W 540 N
Orem, UT 84057-6631

Phone

(801) 661-7007

NPI assigned

Nov 25, 2020

Last updated

Nov 25, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Laura Lynn Huch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Champion Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Orem, UT
  • NPI 1790386837
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1134723505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W 540 N",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840576631",
            "telephone_number": "801-661-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W 540 N",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840576631",
            "telephone_number": "801-661-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBERG",
        "first_name": "LAURA",
        "middle_name": "LYNN",
        "credential": "SUDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "6855070-6006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14997547",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "HUCH",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victoria Ruth Blonquist
• Macie Mariah Bloomer
• Melinda Bluford
• Melissa J. Blumell, CMHC
• Ruby Bluth
• Brian T Boden, PAC
• Jadyn Bohn
• Daniel Bolanos
• Samantha Bolton, DNP
• Bryan Felipe Bonilla-Alberto, CSW

• Addiction (Substance Use Disorder) Counselor in Orem, UT
• Providers in Orem, UT by specialty
• Addiction (Substance Use Disorder) Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.