Provider Demographics
NPI:1366256950
Name:BOILLOT, TANNER (PPS, LEP)
Entity type:Individual
Prefix:MS
First Name:TANNER
Middle Name:
Last Name:BOILLOT
Suffix:
Gender:F
Credentials:PPS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3010
Mailing Address - Country:US
Mailing Address - Phone:408-522-8247
Mailing Address - Fax:
Practice Address - Street 1:739 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-3010
Practice Address - Country:US
Practice Address - Phone:408-522-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA758930103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool