Provider Demographics
NPI:1366324162
Name:BOERNER, TROY DANIEL
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:DANIEL
Last Name:BOERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 BIG SKY TRL
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6685
Mailing Address - Country:US
Mailing Address - Phone:720-339-5571
Mailing Address - Fax:
Practice Address - Street 1:79 WINSTON DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5768
Practice Address - Country:US
Practice Address - Phone:328-430-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician