Theresa Ann Boomer, MS

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

License

246.000083 Issued in IL

Practice address

4 Pine Ridge Cir
Clancy, MT 59634-9760

Phone

(406) 422-0411

NPI assigned

Oct 19, 2011

Last updated

Oct 19, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Ms. Theresa Ann Hopkins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1205111499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 PINE RIDGE CIR",
            "city": "CLANCY",
            "state": "MT",
            "postal_code": "596349760",
            "telephone_number": "406-422-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 PINE RIDGE CIR",
            "city": "CLANCY",
            "state": "MT",
            "postal_code": "596349760",
            "telephone_number": "406-422-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMER",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-19",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "IL",
            "license": "246.000083",
            "primary": true
        },
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "TN",
            "license": "GC0000000027",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF GENETIC COUNELING CERTIFICATION",
            "identifier": "2002038",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED GENETIC COUNSELOR",
            "identifier": "246.000083",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED GENETIC COUNSELOR",
            "identifier": "GC0000000027",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "HOPKINS",
            "middle_name": "ANN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Roy Bell III, L.AC
• Roger Bisson, DDS
• Susan Blum
• BSCH Clancy LLC (Elkhorn Healthcare and Rehabilitation)
• Emily Ann Burton, RN
• Chronic Disease Management, LLC
• Clancy Nursing and Rehab Center LLC
• Joseph Elliott Cole, CCEMT-P

• Genetic Counselor (M.S.) in Clancy, MT
• Providers in Clancy, MT by specialty
• Genetic Counselor (M.S.) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.