Amanda Boman

Individual provider Active NPI Clinical Social Worker · Edgerton, WI

NPI 1720457948 · NPPES record last updated Mar 7, 2022

Key facts

NPI
1720457948
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
Practice address
11101 N Sherman Rd
Edgerton, WI 53534-9002
Phone
(608) 884-3441
NPI assigned
Sep 17, 2015
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD)
Yes

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Yes

Addresses

Primary practice location

11101 N Sherman Rd
Edgerton, WI 53534-9002

Mailing address

11101 N Sherman Rd
Edgerton, WI 53534-9002

Other providers in Edgerton, WI

All providers in Edgerton, WI · Clinical Social Worker in Wisconsin

Sources for this page

Verify at the official NPI Registry.