Justin Lee Boe

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1522 E Superior St
Duluth, MN 55812-1634

Phone

(218) 391-3215

NPI assigned

Jan 13, 2020

Sex

Male

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

Practice roles

Locations

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.

• Accend Services Incorporated

  • Adult Mental Health Clinic/Center
  • Duluth, MN
  • NPI 1417023458
  NPD

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1972143444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022086",
            "telephone_number": "218-391-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121634",
            "telephone_number": "218-391-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOE",
        "first_name": "JUSTIN",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Ann Bluth, DDS
• Daniel Alejandro Bly Laguna
• Liv Petra Bly, PA-C
• Kimberly Anne Boddicker, MD
• Mariah Bodle
• Andrea Nicole Boehland, MD
• Barbara Ann Boehm, PSY.D, LP
• Nicole Boehm, OTR/L
• Eric David Boehmer, MD
• David Allen Bohil, CCC/SLP

• All providers in Duluth, MN
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.