Stacey Lynn Bolyard, EDD, PPS

Primary specialty

School CounselorTaxonomy code 101YS0200X

License

200204775 Issued in CA

Practice address

4210 Technology Dr
Fremont, CA 94538-6337

Phone

(510) 657-2350

NPI assigned

Sep 9, 2024

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 names 1

• Stacey Lynn Bamford Former name

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": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1952137788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 TECHNOLOGY DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945386337",
            "telephone_number": "510-657-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 TECHNOLOGY DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945386337",
            "telephone_number": "510-657-2350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4455 Seneca Park Ave",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945384028",
            "country_code": "US",
            "telephone_number": "510-657-2350 x12367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLYARD",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "EDD, PPS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "CA",
            "license": "200204775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "BAMFORD",
            "middle_name": "LYNN",
            "credential": "PPS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gloria Boehm-Yu
• Carina Ramirez Bojorquez
• Amrit Kaur Bola, NP
• Britni Bolden
• Vincent Bologna
• Jyotsna Bomdica, MD
• Ashley Bonilla
• Berenise Bonilla
• Bryant E Bonner, MD
• Jared Bonoan

• School Counselor in Fremont, CA
• Providers in Fremont, CA by specialty
• School Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.