Lacey Bolduc, MSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

565 Union St NE Ste 100
Salem, OR 97301-2416

Phone

(971) 719-2440

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Lacey Brown Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Rooted Mental Health LLC

  • Clinical Social Worker
  • Salem, OR
  • NPI 1073219507
  NPD (past)

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1396579124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 UNION ST NE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012416",
            "telephone_number": "971-719-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 UNION ST NE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012416",
            "telephone_number": "971-719-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDUC",
        "first_name": "LACEY",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "BROWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Angela Kathryn Bohlke, M.D.
• Eric Anthony Bohm, RPH
• Alec Thomas Boike, MD
• Elizabeth Boland, MSCP, LPC, NCC, CADC
• Danielle Bolanos
• Boline Chiropractic Clinic, LLC
• Keith W Boline, D.C.
• Neptali Pastor Bolivar
• Lucy Bollinger
• Ashley Boltjes, LMT

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.