Michelle Boltz, PLADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

P-2175 Issued in NE

Practice address

2112 W Faidley Ave
Grand Island, NE 68803-4670

Phone

(308) 398-5895

NPI assigned

Aug 20, 2024

Last updated

Aug 20, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1508698275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "ALDA",
            "state": "NE",
            "postal_code": "688100092",
            "telephone_number": "308-850-6426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034670",
            "telephone_number": "308-398-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTZ",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PLADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NE",
            "license": "P-2175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myra Boje
• Flora Elsa Bolin, CRNA
• Amy Marie Bolles
• Brent Wayne Bollwitt, PHARMD
• Mark Edwin Bolton, PH.D., M.D.
• Audreana M Bombeck, PT
• John Bomberger
• Koeby Bonner, DPT
• Tamara Lynn Bonnes-Heil, O.D.
• Douglas Alan Boon, MD

• Addiction (Substance Use Disorder) Counselor in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Addiction (Substance Use Disorder) Counselor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.